Credit Card Payments 

Name (as it appears on the card):____________________________________________  

Email address:_______________________________

Company Name(when applicable):________________________________________________

Credit Card:  Visa ___     Mastercard ____  Discover ____

Billing Address: _________________________________________


City: __________________  State:______ Zip: ________


Card Number:__________________________________Expiration Date:__________


Three Digit Code:_________________ Amount:_______________

By signing below, I authorize Landlord Connection, Inc. to bill my account for the amount listed above:

Authorization Signature:_________________________________Date: ____________


Mail payments to:                                             Or you can fax to:  603-424-4032

Landlord Connection, Inc                               Attn:  Accounts Receivable

PO Box 1387

Merrimack NH 03054