If you want to have a recurring order Please return this form by fax to 954 518 4255, email to firstname.lastname@example.org or by mail to
Plan Time Inc
1241 Stirling Rd. #117 Dania ,FL 33004
Recurring Payment Authorization Form
If you would like to enjoy the convenience of automatic recurring billing, simply complete the Credit Card Information section below and sign the form.
All requested information is required.
Upon approval, we will automatically bill your credit card for the amount indicated and your total charges will appear on your monthly credit card statement.
You may cancel this automatic billing authorization at any time by contacting us.
Customer Name as used for Order
Plan Time Inc. Makers of Time Traveler
I authorize Plan Time Inc. makers of Time Traveler to automatically bill the card listed below as specified:
Executive Diary Diary Diary
Medium Weekly Diary Pocket Diary
Start on /
choose End Date /
No end date
Credit Card Information (to be completed by customer)
Card type (Choose one)
(as shown on card)
Cardholder ZIP Code
(from credit card billing address)
Expires / CCV CODE
We will email you when credit card is charged.This will happen in advance of shipment as we prepare our recurring orders ahead. (Make sure email address above is correct.)