Credit Card Authorization Form (B2B)

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									This Credit Card Authorization form is designed to provide a formal way to manage
credit card authorizations and payment schedules for a customer, individual, or a
business. This authorization form contains both standard clauses and opportunities for
the use of optional terms, and conditions making it fully customizable to fit the needs of
the contracting parties. Use this standardized, easy-to-use form to enhance your billing
process and procedures.
                                       COMPANY NAME/LOGO
                                 CREDIT CARD AUTHORIZATION FORM



PAYMENT OPTIONS – Select a payment option
 One-Time Payment

 Monthly Auto-Payment

 Other Payment



CREDIT CARD INFORMATION
NAME (as it appears on credit card):

BILLING ADDRESS:

CITY, STATE, ZIP:                                                PHONE NUMBER:

CREDIT CARD TYPE:
                   VISA           MASTERCARD                  DISCOVER     AMERICAN EXPRESS

CARD NUMBER:                                           SIGNATURE CODE:       CARD EXPIRATION DATE:

ACCOUNT #:                                                                   PAYMENT AMOUNT:




AUTHORIZATION

I hereby authorize [COMPANY NAME] to charge the above referenced account for [Insert
Description of Products and/Services].



NAME (PRINT): ________________________________________                           DATE: ________________

NAME (SIGN): ________________________________________




© Copyright 2011 Docstoc Inc. registered document proprietary, copy not                       2
                                           COMPANY NAME/LOGO
                                     CREDIT CARD AUTHORIZATION FORM

								
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