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Strides in Psychotherapy 732-873-5570 15 Clyde Rd. Suite 102 Somerset NJ 08873 66 Maple Avenue Morristown NJ 07960 Tammy Dorff Psy. Type of Card Visa Mastercard etc. Card Number Expiration Date Security Code Name of Card Holder Signature of Card Holder Date Billing Address of Card Holder. D. NJ Lic 3950 Linda Tamm Psy. D. NJ Lic 3926 Authorization for Credit Card Use I authorize Strides in Psychotherapy hereinafter Strides to charge money owed to it onto my credit card for treatment rendered...

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