Download Sample Credit Card Authorization Form Template | PDF | Word

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The sample credit card authorization allows a person to be able to pay with a credit or debit card when the details are obtained via fax, over the phone, or by writing down if the card machine is not working.

How to Fill-in

The person accepting the card must take down the following information in order to process the card at a later time:

  • Cardholder’s and Customer’s Names
  • Type of Card (Visa, MasterCard, American Express, Discover, or other)
  • Name on Card
  • Card Number
  • Expiration Number
  • Billing Address
  • And the Signature of the Party Present (if available)

After the form has been completed it should remain on file for the next 120 days in case the payee disputes the charge with the credit card company.

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