Credit/Debit Card Change Request Card change request must be submitted 48 hours in advance and no later than Thursday morning to ensure all changes are made prior to weekend. If cc failure occurs over the weekend then the enrollee will be responsible to fill out a reinstatement form as well. NO EXCEPTIONS! Today's Date* Date Format: MM slash DD slash YYYY Enrollee Name* First Last The name of the offender that is enrolled on the Shadowtrack program.Enrollee Phone Number*NOTE: This must match the number we have in the system. If you need to change that number, you must complete the Phone Number change request form.Email Once payment is made, we will use that card number for your weekly monitoring fees and remove your previous card. Please note the card placed on file will be charged weekly unless another method of payment is submitted prior to the next billing cycle. There will be no refunds or exceptions. If the cardholder disputes the charges with us or the bank, due to fraudulent activity, the enrollee account will be disabled and assessed a $50.00 reinstatement fee. In addition, charges will be filed against the enrollee for illegal use of a credit card.Billing Information Enter your payment details below.Card Change Fee*Card Change $20.00RUSH Card Change $30.00Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Receipt To* A copy of this receipt will be emailed to this address. This iframe contains the logic required to handle Ajax powered Gravity Forms.