Please Enter Your Credit or Debit Card Information Date* MM slash DD slash YYYY Company Name Your Name* First Last Email* Phone*Address*Use address associated with your Credit/Debit card. Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Card Type?* Debit Card Credit Card Card Number (No Spaces)* Expiration* Security Code (CVV)* HiddenAuthorizationI authorize Kings Royal Services LLC (DBA Kings Royal Media) to charge my credit/debit card every month for the amount due.Authorization*I authorize Kings Royal Services LLC (DBA Kings Royal Media) to charge my credit/debit card for the amount due. Yes No Signature*CommentsThis field is for validation purposes and should be left unchanged.
