Autopayment Credit Card Authorization FormThis is an auto payment agreement for Efoyta Ider to take auto deductions from the members debit or credit card Please enable JavaScript in your browser to complete this form.Cardholder Name *FirstLastBilling Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePayment Confirmation *I hereby authorize Efoyta to charge my credit card with the annual renewal and death benefit contributions.Credit or Debit Card Details16 Digit Card Numbers *Exp Date *3 digit Code *Date of AuthorizationDate *Submit