Will HumphreysWill HumphreysVirtual Assistant & Healthcare Recruiting Expert

Master Payment Authorization Form

PDF · 9 May 2026
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This document is a payment authorization form dated 04/08/2024, signed by Philip Olasa on behalf of Pinecrest Capital Management. It authorizes Rockstar Recruiter, LLC to charge the listed VISA credit card (account number 4266 8418 1033 1700, expiration 03/29, security code 756) for fees under the Billing Staff Services Agreement. The form includes the cardholder’s billing address, a statement of responsibility for any charges or late fees, an indemnification clause protecting the depository institution and third‑party processors, a compliance affirmation that entries will not violate Arizona or U.S. law, and a reminder that the cardholder must notify Rockstar Recruiter of any changes to contact or billing information. The form concludes with the cardholder’s signature and a reference number (4879‑8119‑5890).

Topics

Payment Authorization Details

Specific credit card information, billing address, and the explicit permission for Rockstar Recruiter to charge the card for services.

Legal Indemnity and Compliance Clause

Indemnification of the depository institution and third‑party processors, and affirmation that no entries will violate Arizona or U.S. law.

Responsibility and Notification Obligations

Cardholder’s responsibility for charges, late fees, and the duty to inform Rockstar Recruiter of any changes to address, phone, email, or billing details.

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