| Name: |
|
| Email Address: |
|
| Please Select Credit Card Type |
Visa
MasterCard
American Express
Discover |
| Expiration Date |
|
Security Code:
(Security code is the 3 digit number found on the back
of your credit card, usually on the signature line.) |
|
| Card Owner/Name on Card
|
|
I authorize Cleinman Performance Partners charge the card listed 50% ($4,250) to initiate the engagement and 50% will be due upon delivery of the final report.
Payment method will be consistent with the option selected above.
|
Yes
No |
| Date |
|
|
|
