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.