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One (1) Time Credit Card Payment Authorization Form

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A one (1) time credit card payment authorization form gives a merchant the right to charge a customer’s credit card a single time without the physical card being physically present. Obtaining the customer’s approval with the form gives the merchant protection in the event a chargeback is initiated.

The following information is needed in order to complete the form in full:

  • Full name and address of the cardholder;
  • Merchant name;
  • Amount of charge ($);
  • Date (mm/dd/yyyy) that the charge will occur;
  • Card type used (VISA, Discover, etc.);
  • Card number (#), expiration date, CVV, and ZIP; and
  • Cardholder signature.

When to Use

A merchant can make use of the form whenever they intend to charge a customer in their absence. This may be necessary if the merchant doesn’t have a way of knowing the exact amount that will be owed until a later date. By obtaining a signed authorization form, the merchant can charge the card without having the customer come back to the business in person.