An authorization will be obtained based on estimate and / or a final charge will be processed once work is completed based on final invoice. Please have a company representative responsible for incurring expenses complete this online form and submit the form to BCVA Inc. The electronic signature grants your permission for BCVA Inc. to authorize and / or bill the card accordingly. Other terms available are C.O.D. (cash due on completion of contracted services) or Net 30 (Net 30 Credit Application must be received and approved prior to any work being done.) BCVA Inc. is not responsible for third party collections. Charges submitted by BCVA Inc. are due promptly according to terms without regard to when a third party might pay your company.

* I am submitting credit card information for:
Authorization of Pre-Production Estimate      Payment of Final Invoice
* Credit Card Type
* Credit Card Number
* Credit Card Expiration
* Security Code Located on Back of Credit Card
* Card Holder’s Name
* Card Holder’s Phone Number
* Card Holder’s Email
* Billing Contact
* Billing Department
* Billing Phone Number
* Billing Email
* Company Name
* Street Address
Address Line 2
* City
* State / Province
* Country
* Zip / Postal Code
* P.O. Required? Yes    No
  I have Read and Agree to BCVA Inc.’s Terms and Conditions
* Today’s Date    
* Electronic Signature (Please Type Name)