Gift card credit card authorization form
®
Billing Information
Company Name:____________________________ Name as it appears on credit card:___________________________________
Address:__________________________________________________________________________________________________
City:________________________________________________ State:______________________ ZIP:______________________
Total amount to be charged: $_______________________ (please transfer amount from previous page and include shipping charges if applicable)
Cardholder’s signature:__________________________________________________ Date:_______________________________
The cardholder agrees to the credit card amount shown hereon and agrees to perform the obligations set forth in the cardholder’s agreement with the issuer.
*************************************** For Circuit City Stores, Inc. use only ***************************************
AZV? [ ] yes [ ] no (If no, sale cannot be processed) Authorization code: _______________________
Was charge approved and order can be processed? [ ] yes [ ] no
Last four digits: __________
Supervisor approval: __________________________________ Date: ___________________
*************************************** For Circuit City Stores, Inc. use only ***************************************
Card type: [ ] American Express [ ] Visa [ ] Mastercard [ ] Discover
Credit card number:_________________________________________ Exp date:_________________
Card ID number:________________________ (for Visa, Mastercard and American Express only - see below for explaination)
What is the Card ID Number and why do you need to know it?
The Customer Identification Number (CID or CIN) is a three or four digit number that is unique to each card. This additional
security feature is designed to protect the consumer by helping to ensure the card is present during the purchase. It is printed
only on the card, never on any receipts or statements. The number is verified by the card issuer during the purchase.
Visa, Mastercard and Discover accounts: CIN (3-digit) can be found on the back of the credit card, in the signature block, after your account number
American Express accounts: CID (4-digit) can be found on the front of the credit card, to the upper right (or left) of the account number
*************************************** Questions - please email us at giftcardsales@circuitcity.com ***************************************