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

Parvathi Vijayamohan

20 June 2022

4 min read

Credit card authorization form templates are easy-to-use forms that can give your customers the option to automate credit card payments.

In this article, we are going to:

What is a credit card authorization form?

A credit card authorization form gives a business the authority to charge a customer’s card on a one-time or recurring basis during a specified period. For the credit card authorization process, the document requires the cardholder’s written or e-signature. Then, your business can charge the card a fixed amount for the specified period.

Credit card authorization forms are a crucial tool for the following scenarios:

  • Card Not Present (CNP) transactions – a type of transaction where the card and its cardholder are physically absent at the time of the transaction. A credit card authorization form acts as an additional proof of payment in case of a chargeback.
  • Recurring payments – like subscriptions, memberships, bills, and utilities. Such a scenario also involves automation in the form of payment software. These items ensure that you get the payments on time without having to take the customer’s permission.

Credit card authorization form templates are helpful in this case because they save you the trouble of creating a form from scratch.

Credit Card Authorization Form Template

Here’s an example of a blank credit card authorization form.

This format is pretty flexible and it lets you customize it into whatever you need – like an airline credit card authorization form or a hotel cc authorization form. Additionally, our whitelabeling feature helps you make it your own, and our omnichannel sharing makes it fast and easy to connect with the client for approval and sign-off.

Moreover, you can limit survey data access to a restricted set of users. Sign up below to try out these features absolutely free for 14 days.

Types of Credit Card Authorization Form Templates

Here are three types of cc authorization forms that are frequently used in business. Feel free to copy and customize the content below.

#1. One-Time Credit Card Authorization Form

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.

cc authorization form question: Card Type

Recurring Payment Authorization 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.

cc authorization form question: Merchant Name

Third Party Credit Card Authorization 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 _____________

cc authorization form question: Signature

FAQs

What should be on a credit card authorization form?

Your credit card authorization form ought to include the following details:

  • The credit card information like card type, the cardholder’s name, the card number, and the card expiry date.
  • The merchant’s business information – like name, address and contact number/mail ID.
  • A billing address for the cardholder.
  • A paragraph authorizing the merchant to withdraw the specified amount from the specified card.
  • The card holder’s full name and signature.
  • Date.

Can I include a CVV on the cc authorization form?

Ideally, you shouldn’t, because that can make it easy for criminals to perpetuate card fraud. PCI compliance standards require businesses that process, store, or transmit credit card information to limit physical access to cardholder data.

Parvathi Vijayamohan

Growth Marketer at SurveySparrow

Fledgling growth marketer. Curious about all things SaaS. Aunty to a naughty beagle.

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