Recurring Payment Authorization

For your convenience, Premier Grease can automatically service your location on a recurring basis! To authorize Premier Grease to charge your credit card after each service is performed, fill out the below form.

After submitting the form, a Premier Grease representative will call you at the provided phone number to get the full credit card details from you.

If you prefer, you are also welcome to call us directly at 800-880-1142 to provide the credit card details.

Credit Card Authorization Form

* Indicates required field

Restaurant / Facility Name *

Comment *

Name *

First

Last

Email *

Phone Number *

Last 4 digits of credit card *

Authorization *

I authorize Premier Grease to service my restaurant on a recurring basis, and charge the credit card referenced above, on a recurring basis until further written or email cancellation notice.

Please note, Weekly service is every 7 days, Bi-Weekly is every 14 days, Monthly is every 4 weeks, Bi-Monthly is every 8 weeks, Quarterly is every 12 weeks, Bi-annual is every 26 weeks, and Annual is every 52 weeks.

Submit

Credit Card Authorization Form

SErvices

Company

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