Super Poligrip® Extra Care with Poliseal, 2.2 oz. tube, 6/pkg, 4 pkg/cs (24 Tubes Total)

I hereby authorize Frontier Dental to initiate transactions to the Credit Card listed below, and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until written notification is received to cancel authorization with reasonable time to act upon it.