(To sign up for a Target Express Debit Account please print this form, complete the form, and fax to 630-789-4901. Any questions please call 630-789-4900)

REALINFO

16W347 83rd Street
Suite D
Burr Ridge, IL 60527
Phone (630) 789-4900
Fax (630) 789-4901
www.realinfo.net

Target Express Debit Account Authorization

Instant convenience can be yours with Target Express Debit Account billing from REALINFO! With the return of this form we will bill your credit card number for the amount listed below.

  1. The amount authorized to be billed to Target Express Account is to be used within one year and any remaining balance is non refundable. There is a $100.00 minimum charge to start Target Express Debit Account. Any additional charges made to maintain your Target Express Debit Account must be made in $100.00 or more increments.
  2. Credit card payments processed though Target Express Debit Account will be treated exactly as if cash or a check has been made payable to REALINFO.
  3. As items are charged with Target Express Debit Account a remaining balance will show on the Target Express receipt page. Please print this page for verification. Upon request a statement of the charges posted to your account will be sent via US Mail to your billing address that is on file with REALINFO. You agree to keep your billing address current.
  4. Charges under Target Express Debit Account cannot be processed for any third party. We will charge the Target Express Debit Account only for accounts registered to the cardholder. All transactions are electronically verified for your protection.

I authorized REALINFO to bill my [ ] VISA, [ ] MASTERCARD, [ ] AMERICAN EXPRESS for all charges incurred, and agree to the terms and conditions.

Target Express Debit Account Amount : $________________________

Card number: ____________________________ Expiration Date: ______________

Signature: ________________________ Email Address:_______________________

Print name EXACTLY as it appears on card: _______________________________

Billing Address: _____________________________________________________             

Phone Number_______________________  Fax Number_________________________