Credit Card Authorization Form Templates (Ready-To-Use + Customizable)

Sign and complete this form to authorize Acme Catering to make a one time debit to your credit card listed below.

By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.Please complete the information below:

I, [cardholder’s name] authorize Acme Catering to charge my credit card account indicated below for [amount] on or after [dd/mm/yyyy]. This payment is for [description of goods/services].

Billing Information

• Billing Address:
• Phone:
• City:
• State:
• Zip:
• Email:
• Card Type:
• Cardholder Name: ____________
• Account Number: ____________
• Expiration Date: ____________

SIGNATURE:

DATE:

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only.

Furthermore, I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Sign and complete this form to authorize regularly scheduled charges by Wayne Enterprises to your credit card.

You will be charged the amount indicated below for each billing period. A receipt for each payment will be provided to you and the charge will appear on your credit card statement. Moreover, you agree that no prior permission will be sought unless the date or amount changes, in which case you will receive notice from us at least 7 days prior to the payment being collected.

I, [Cardholder’s Name] authorize Wayne Enterprises to charge my credit card account indicated below for [amount] on the [day] of each [week/month].

Billing Information

• Billing Address:
• Phone:
• City:
• State:
• Zip:
• Email:
• Card Type:
• Cardholder Name: ____________
• Account Number: ____________
• Expiration Date: ____________

SIGNATURE ___________

DATE _____________

I understand that this authorization will remain in effect until I cancel it in writing. I agree to notify, in writing, of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date.

Furthermore, I certify that I am an authorized user of this credit card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this form.

This is to certify that I, [cardholder name] authorize a charge(s) to my credit card ending in [last 4 digits] for [amount] for the payment of {goods/services] for the following person(s):

• Full Name 1
  Full Name 2, etc

I have reviewed the above and thereby confirm that all of the details are correct. Moreover, I agree to these charges and agree to be bound by all the rules and regulations from my credit card company.

SIGNATURE ___________

DATE _____________