Leap of Language Inc.

37171 Sycamore Street, Apt. 633 Newark, CA 94560

stcin001@gmail.com

205-534-4330

Authorization for Credit Card Use

By signing this form you give Leap of Language Inc. permission to debit your account for the amount indicated on or after the indicated date. This is permission for current and future services as outlined in this agreement, and does not provide authorization for unrelated debits or credits to your account.

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© 2020 by PIMM-USA. Proudly created for Leap Of Language Inc.

Speech Therapy in Newark | Language Therapy in Newark | Pediatrics 94560

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