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Automatic Credit Card Authorization (a.k.a. AutoPay)

AUTOMATIC CREDIT CARD DUES PAYMENTS can assist you in paying your dues on time. You may elect to have your credit card automatically debited on a monthly or quarterly basis. To choose to pay your dues with the credit card option, you must complete the bottom half of this form and return it to the CPMA office no later than Thursday, January 31, even if you signed up last year.

  • The credit card you use must be valid through Wednesday, December 31;
  • If your card is declined more than once, we will no longer be able to include you in the automatic debit plan with the declined credit card
  • At least one-fourth of your dues must be paid by March 1, one-half by June 1, three-fourths by September 1, and 100% (the balance) by December 1.

The charges will usually be processed during the third week of the month. However, the timing may vary and we cannot guarantee the date.  CPMA is not responsible for your credit card cycles and cut off dates.

If you have any questions, contact the Debbie at (860) 586-7512/(800) 627-3668 or by email at infocpma@cpma.org.

Return form by mail or fax to:  CT Podiatric Medical Association (CPMA), 342 North Main Street, Suite 301, West Hartford, CT 06117-2507 or Fax #: (860) 586-7550.


CT Podiatric Medical Association

Credit Card Authorization

 

I, ____________________ (please print), hereby authorize the CT Podiatric Medical Association (CPMA) to debit the following account as detailed below:

American Express       MasterCard       VISA

(Circle One)
Exp. Month:    ________
Exp. Year:      ________ 
Credit Card Number:     _____________________________

Equal debits made:
_____     Monthly (11 payments)
_____     Quarterly (4 payments)

Payment Amount:     $___________
Name as on Card:     __________________________________________
Signature: __________________________________________________