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    Credit Card Authorization Form Template 02

    Uploaded by

    Liza wong
    This document is a credit card recurring payment authorization form that allows customers to automatically charge payments to their credit card on a recurring basis. It lists the benefits of recurring payments such as convenience and ensuring payments are on time. It then provides instructions on how recurring payments work, including authorizing regularly scheduled charges to a credit card and receiving receipts via email. The bottom section requests customers to provide their name, billing address, phone number, email, credit card information, signature, and date to authorize the business to charge their card according to the terms outlined in the form.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Credit Card Authorization Form Template 02

    Uploaded by

    Liza wong
    283 views2 pages
    This document is a credit card recurring payment authorization form that allows customers to automatically charge payments to their credit card on a recurring basis. It lists the benefits of recurring payments such as convenience and ensuring payments are on time. It then provides instructions on how recurring payments work, including authorizing regularly scheduled charges to a credit card and receiving receipts via email. The bottom section requests customers to provide their name, billing address, phone number, email, credit card information, signature, and date to authorize the business to charge their card according to the terms outlined in the form.

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    This document is a credit card recurring payment authorization form that allows customers to automatically charge payments to their credit card on a recurring basis. It lists the benefits of recurring payments such as convenience and ensuring payments are on time. It then provides instructions on how recurring payments work, including authorizing regularly scheduled charges to a credit card and receiving receipts via email. The bottom section requests customers to provide their name, billing address, phone number, email, credit card information, signature, and date to authorize the business to charge their card according to the terms outlined in the form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    283 views2 pages

    Credit Card Authorization Form Template 02

    Uploaded by

    Liza wong
    This document is a credit card recurring payment authorization form that allows customers to automatically charge payments to their credit card on a recurring basis. It lists the benefits of recurring payments such as convenience and ensuring payments are on time. It then provides instructions on how recurring payments work, including authorizing regularly scheduled charges to a credit card and receiving receipts via email. The bottom section requests customers to provide their name, billing address, phone number, email, credit card information, signature, and date to authorize the business to charge their card according to the terms outlined in the form.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    <Insert Logo Here>

    < Street Address>


    < City State Zip>
    < Phone Number>

    Credit Card Recurring Payment Authorization Form

    Schedule your payments to be automatically charged to your credit card. Just complete and sign this
    form to get started!

    Recurring Payments Will Make Your Life Easier:


     It’s convenient (saving you time and postage)
     Your payment is always on time (even if you’re out of town), eliminating late charges
     You can get Rewards Points for paying your bill

    Here’s How Recurring Payments Work:


    You authorize regularly scheduled charges to your Visa, MasterCard, American Express or Discover card.
    You will be charged each billing period for the total amount due for that period. A receipt will be emailed to
    you and the charge will appear on your credit card statement. You agree that no prior-notification will be
    provided if the total payment is under <insert $>. If your bill is more than that amount, or the payment
    date changes, you will receive notice from us at least 10 days prior to the payment being collected.

    Please complete the information below:

    I ____________________________ authorize <Insert Business Name> to charge my credit card

    (full name)

    indicated below on the ________ of each <insert frequency> for payment of my <insert type of bill>.
    (day or date)

    I understand that I will only receive advance notice of the charge if it exceeds <insert $>.

    Billing Address ____________________________ Phone# ________________________

    City, State, Zip ____________________________ Email ________________________

    Account Type: Visa MasterCard Amex Discover

    Cardholder Name _________________________________________________

    Account Number _____________________________________________

    Expiration Date ____________

    CVV (3 digit number on back of Visa/MC, 4 digits on front of AMEX) ______

    SIGNATURE DATE

    I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined
    above. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next
    business day. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the business in
    writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date.
    This payment authorization is for the type of bill indicated above. I certify that I am an authorized user of this credit card and that I
    will not dispute the scheduled payments with my credit card company provided the transactions correspond to the terms indicated in
    this authorization form.

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