Credit card authorization & AutoPay form

Thank you for choosing Solutions Counseling.  Please enter your credit card information into our secure form below.  Contact Customer Service at 763-515-4563 or questions@helpwithsolutions.com with any questions:

Client Name(Required)
Name on Credit Card(Required)
Name of Person Completing this Form(Required)
Credit Card Information(Required)
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Expiration Date
 
Credit Card Billing Address(Required)
Enter Email
Card-On-File Consent(Required)
Auto-Pay Consent (Optional)