Merchant Account Services 

What is a credit card authorization form?

Most merchants require a credit card authorization form to be filled and signed when in the process of buying and selling products or services.

If you need to accept credit cards on your site it is a good idea to compare credit card processing companies' rates before you open a merchant account and commit to their terms and services. Most companies offer FREE QUOTES for their processing fees.


A merchant account is a type of bank account that gives you or your business the ability to accept debit or credit cards for payment online and have the money collected from your customers Visa, MasterCard, AMEX, Discovery and others to be sent to your bank.

Merchant Accounts usually need to be in the same country as the business bank accounts.

If you don't want to use a merchant account, you can apply online for a PayPal Website Payments Pro or a Bank of America Merchant Services account.


Charge-backs can cut you off from the credit card network if your business generates more than a few charge-backs per year. If your customers don’t understand a charge on their credit card statement, they should have a telephone number, web address or email to contact your customer service department and have the issue resolved as soon and as easy as possible.

Usually it takes one to three weeks to have a Merchant Account approved.

Below, please find a generic authorization form that can be modified for your particular needs.


Cardholder Name: ___________________________________________ (Exact name as it appears on credit card)

Billing Address: _______________________________________________________________

Cardholder Phone Number: (______)_______________ E-mail: ______________________

Credit Card Type: _____ Visa _____ Mastercard _____AMEX ____ Discover ____Other

Credit Card Number: ___________________________________________

Expiration Date: ____/____ (mm/yy)

Card Identification Number (last 3 digits located on the back of the credit card): ______

Amount to Charge: $ ______________ (USD)


______ Please bill my credit card ONCE for the amount above.

______ Please apply this payment to the following Order/Invoice# __________________

______ Please bill my credit card MONTHLY for the services provided each month by ______________________________________________________________ (Company Name)

Type of product or service this payment is for: ____________________________________



Number: ___________________________________

Birth Date: ____/____/________ (mm/dd/yyyy)

Gender: _____ Male _____ Female


I authorize ___________________________ to charge the agreed amount listed above to my credit card provided herein. I agree that I will pay for this purchase in accordance with the issuing bank cardholder agreement.

I understand this is only for up to this amount during the time period of "DATES OF CHARGES" referenced above. If additional charges are going to be authorized a new form will have to be completed.

I certify that all information above is complete and accurate.

CARDHOLDER – Print Name, Sign and Date Below:

Signed: ___________________________________________

Dated: ___________________________________________

Name: ___________________________________________

Once signed return the completed form to:

Name: __________________________________________

Street: __________________________________________

City/State/ZIP: ____________________________________________________________

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