Form to fill out when you want to authorize a business to charge your credit card.
Credit Card Authorization Form
Name on the Card: ____________________________
Type of Card: Visa ___ MC ___ AmEx ___ Discover ___ Other ___
Account number____________________________
Expiration Date ____________________________
Security Code ____________________________
Billing Address____________________________
City, State, Zip____________________________
Phone Number____________________________
Order/Invoice Number ____________________________
Item(s) Purchased____________________________
Amount to be Charged____________________________
By signing this form, you authorize____________________________ to charge your card for the amount listed above.
Signed:____________________________ Date: ___________
