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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



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