*First/Last Name:   /  

*Email:

*Contact Phone #:

*Address

*City    State: AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWY    Zip:

I hereby authorize The Rayburn Group to charge my payment method for my monthly service fees. I agree that this is a periodic charge that will be made monthly, and that to terminate the recurring billing process I must cancel my account.

I understand that all account cancellations should be emailed to art@artrayburn.com. I will not dispute my recurring billing with The Rayburn Group through my credit card issuer or bank as long as the amount in question was for service rendered prior to my cancelling my account.

* I give my authorization for this recurring payment