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Credit Card Charge Authorization Form


Have your customer's fill out this form when charging a cardholder who is not physically present at your place of business.




Credit Card Charge Template



Credit Card Charge Authorization


By signing below, I am hereby authorizing the Company to charge my credit card for the purpose that I have checked below.

Card Type:

[__] Visa
[__] Master Card
[__] American Express

Authorized for:

[__] 70% Deposit
[__] Balance Due
[__] Entire Event

Card Number:

________________________________

Expiration Date:

____/ ____/ ______

Security Code: ______

Cardholder's Name:

________________________________

Company Name:

________________________________

Billing Address:

________________________________

City: __________ State: ___ Zip: ____

Telephone Number: ________________



_______________________ Date_____
Cardholder's Signature


FAX TO ACCOUNTING AT: (000)000-0000









Word

PDF



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