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I, the card holder, have read the bill for services rendered from Gourvitz & Gourvitz, LLC. I have reviewed the bill(s) and item(s) charged, as well as any retainers requested. Any disputes or disagreements about any of the charges have already been discussed with Gourvitz & Gourvitz, LLC. and dealt with accordingly to my satisfaction. I have no disputes or disagreements with the bill and agree to the total charge that I am making. I therefore authorize Gourvitz & Gourvitz, LLC. to charge my credit card in the amount specified on the payment portal. I understand that by processing the charge and continuing to the payment portal I am effectively signing this agreement, I will not request any chargeback, refund or credit and I further agree to be bound by this acknowledgment. I further acknowledge that I am the card holder or authorized user of said card, and that I have a right to seek independent counsel prior to acknowledging and I have either done so or have waived my right to same.

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Gourvitz & Gourvitz LLC.

New Jersey
505 Morris Avenue
Suite 102
Springfield, New Jersey 07081
Telephone: (973) 467-3200
Fax: (973) 467-4091
New York
142 West 57th St
11th Floor
New York, New York 10019
Telephone: (212) 586-1700

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