Credit Card Detail Gathering Sheet

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Credit Card Detail Gathering Sheet Powered By Docstoc
					DATE: _____________________


               Credit Card Information for purchase of
                  Services by ABC Company, Inc.


BELOW TO BE FULLY COMPLETED BY CLIENT (once completed
please email back or fax back to 888.555.5678):


VISA          MASTERCARD                 Discover         AMEX

(please circle one above)


Card Number ______________________________________ Expiration Date ________

3 Digit Code on Back of Card____________________

Name of Cardholder (please print)

Billing Address of Cardholder

Amount to apply to credit card

Phone Number of Cardholder________________________________________________

Email Address of Cardholder ________________________________________________

Authorized Cardholder Signature


Add this card to pay monthly hosting payments automatically? (Circle one)   Yes   No

IF FUNDS ARE NOT AVAILABLE, A SERVICE CHARGE OF $15.00 MAY BE APPLIED TO
YOUR ACCOUNT.

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Description: This is a simple credit card form that you can send to clients to collect payment information.