Authorization for Automatic Payment Form

The recurring credit card authorization form is a document that authorizes a business (for example. B utility bills, various subscriptions, car payments, etc.) to automatically deduct payment from a person`s bank account or credit card account. Payments are settled at the end of the billing period for each invoice. If you authorize recurring payments, you will be charged at about the same time each month until payments end because the purchase is completed or until the authorization is revoked by the cardholder. In addition to the information you`ve documented above, these documents require the details of the credit card from which you want the merchant to withdraw money. This requirement can be met in the “Card Details” section. The first task is to check the “Visa”, “MasterCard”, “Discover” or “American Express” box to indicate the type of credit card to be used by the merchant. In the following example, the cardholder uses an American Express card. Next, enter the full name of the person that this credit card considers to be the account holder in the blank field labeled “Cardholder Name.” Note the full account or credit card number from which you wish to withdraw the money on the following line (“Account Number/CC”). Next, note the “expiration date” of that credit card as a two-digit month and a two-digit year in the preformatted boxes under the credit card number you registered. Most, if not all, credit cards have a card verification value on the back of the card via the signature area.

Usually, this is a three-digit number (but it can go up to four). You must specify this number in the empty field labeled “CVV”. Finally, enter the “postal code” used in the billing address of the credit card you are documenting in the empty field labeled “Postal code”. A recurring payment is usually made weekly or monthly. This is especially common with gym subscriptions, software subscriptions, and other repetitive payment authorizations. There are two ways for a business to accept a recurring credit card payment. when a customer is physically present or when a customer lands online on a company`s website. In either case, any business that charges recurring credit card payments will need accounting software like Quickbooks that can generate reports and track customer transactions. The documents on this page can be downloaded from the image buttons or links above. Note that three buttons appear so that you can download this authorization template as a PDF or word processing document. The traditional route and the most used format before the arrival of the Internet.

For gymnastics companies, this is a standard procedure, as each gym tries to link its customers to a recurring monthly credit card payment. In order to legally accept a recurring credit card payment from a customer in person, the company must obtain the customer`s signature. At the end of the process, the company must keep the form on file for as long as the person is a customer. The advantage of offering a recurring credit card payment online is that it is much easier and less paperwork. Most websites only require their customers to read a “Terms of Service” or click an “Accept Terms” button, which gives the company the right to charge a recurring credit card payment when the purchase is made. Companies that offer an online service can also offer a free trial, which, if the customer does not cancel, allows the company to make a recurring payment after the free trial expires. In order for the merchant and the credit card company to authorize this transaction, you will need to provide additional verification of your identity. You must enter the credentials requested in the “Billing Information” exactly as it appears on your credit card bill. The space entitled “Billing Address” is reserved for the building number, the street name and (if applicable) the apartment number indicated in your billing address. Just below this line, the “city, state, zip code” will need the rest of your billing address listed there. Some additional required information is used both to verify your identity and to provide an instant contact method that the merchant or credit card company can use to contact you fairly quickly. Provide a well-maintained “phone number” and “email” address that these entities can use to contact you as needed.

Make sure these items are correct and up-to-date. The first paragraph contains the wording required to regularly authorize the same credit card payment to a particular merchant. Just below this first paragraph, you need to complete a statement with important information. First, enter your name in the white that says “Cardholder Name.” Be sure to present this item exactly as it appears on your credit card. In the blank line that says “Merchant Name,” enter the full name of the merchant (or seller) that you authorize to charge your credit card periodically in the future. This name should appear exactly as it does in books. You will need to specify exactly how much the above merchant can charge your card and how often this amount should be charged. Specify the total amount of money that the trader can charge you in the blank line after the dollar sign. You must now specify how often this payment amount can be withdrawn from your card by the merchant. You can approve a payment made once a week, once a month, or in any other period you choose, as long as you clearly document it. The blank line labeled “Day” accepts either the double-digit calendar day of the month in which you approve the payment in question, the day or week, or another due date. Of course, we must indicate whether you approve a weekly payment, a monthly payment, a quarterly payment, etc.

by providing this information in the empty field titled “week, month, etc.” In the following example, we specify a recurring payment that is made by credit card on the 2nd of each month. In most cases, cancelling recurring credit card payments can simply be done online. For other businesses, this may need to be done over the phone or by signing a consent form. If you don`t know the company, there`s usually a phone number listed on your bill. Otherwise, searching for the name of the payment description in Google is the best bet to find the merchant. 1 – Use the document on this page to set up a recurring credit card payment The last paragraph of this template requires a final preparation before you can sign it. Complete this binding statement with the name of the merchant who will receive money from your credit card in the empty field immediately after the words “.” I agree to notify. You must sign your name in the signature line labeled “Cardholder Signature” and then enter the current calendar date in the adjacent line (“Date”).

5 – Only a signature authorized by you will put this document into force. .