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Letter of Authorization

I , authorize The Medical Mandate Advisors D.B.A OSHA Resource Group to charge my Credit Card/ACH Bank Account indicated below for the plan which will be bill at $/monthly. . I understand that this is a value of a 12 month subscription. The rate above will auto renew 12 months from now, unless notification is provided in writing 30 days from cancelation. Should the OSHA Resource Group fail to provide services provided cancellations may take place at any time. There are no termination fees. Once billed and product delivered, You must cancel within 15 days prior to your billing date to avoid any future monthly charges. Any questions regarding billing should be directed to (800) 674-2584 or ops@osharesourcegroup.com

Billing Information

Billing Address

Phone #

Email:

Card/Account Details

Visa Mastercard Discover American Express ACH

Account Holder Name

Account/CC#

You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated above each billing period. A receipt for each payment will be provided to you and the charge will appear on your credit card statement. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Medical Mandate Advisors D.B.A OSHA Resource Group in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.

DATE May 1, 2024

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Timestamp

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May 12, 2021 3:19 am PDT

Letter of Authorization Uploaded by Rishawn Newman - admin@osharesourcegroup.com IP 174.78.0.138