Credit Card Authorization Form

Credit Card Authorization Form

Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.

Credit Card Information

Card Type
Expiry Date

Billing Information

Billing Address
Street Address
Building/Suite/Apartment #
City
State/Province
Zip/Postal
Country
Enter the same email address you signed-up with.
Shipping Address

Shipping Information

Shipping Address
Street Address
Building/Suite/Apartment #
City
State/Province
Zip/Postal
Country

Permission

By signing this form, you give us permission to debit your account for the amount discussed in your concierge order. This is permission for MI’s Concierge Team to order on my behalf, any requests I make (Meal Prep Services, Supplement Ordering and/or any other Requests).
I authorize Muscle Intelligence to charge my credit card above for agreed upon purchases (Meal Prep Services, Supplement Orders, Concierge Requests). This payment authorization is for the good/services described above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.