Service Authorization Form

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Authorization Received

Thank you! Your signed authorization has been recorded.
A confirmation will be sent to your email.

Personal Information

Full Name *

Please enter your full name.

Phone Number *

Please enter a valid phone number.

Email Address *

Please enter a valid email address.

Identity Document

Photo ID *

📷 Take Photo Open camera

🖼️ Upload from Gallery Photos & files

Please provide a photo of your ID.

Authorization & Agreement

I authorize the charge to my card for the service I have requested. I understand this is a one-time service fee and becomes non-refundable once the service is completed. I confirm that I have received the service.

I authorize the charge and acknowledge the terms above.

I have read and accept the Terms and Conditions.

Please check both boxes to continue.

Signature *

Please provide your signature.