Blank Credit Card Authorization Form

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Word Version

The blank credit card authorization form allows a company or representative to accept payment for a service or product to be charged at a later date. Once signed by the cardholder or approved person the company has the authority to charge the card at the appropriate time.

In order to complete the following details must be obtained:

• Card Number and Expiration
• Billing Address
• Security Code on Back (if American Express the 4 digits are located on the front)
• Cardholder or representative’s signature.

Adobe PDF – MS Word – Rich Text Format