ERJE ROD LARSON ( Name on Card Card Number Address 0 Amex 0 Visa 0 Mastercard 0 Discover Exp Date City State Zip I authorize Caring People Homecare to automatically charge this credit card and subsequently any credit card given verbally/telephonically for all services rendered. Signature Date

ermore, if any such electronic debil(s) should be returned by my financial institution as unpaid (Non-Sufficient or Uncollected Funds). I authorize. Caring People Homecare to collect a returned item fee of 925.00 (or the maximum amount allowed by state law) per item by electronic debit from the same account identified