Below you will find our credit card authorization form. Please print this form, complete, and sign it. Then fax the completed form and a legible copy of the back of the credit card to [Company Fax]

Thank you for choosing [Company Name].

[Company Name] - Credit Card Authorization Form

1. Product _________________________________________
2. Card Number _____________________________________

3. Expiration Date _________________________________
4. Cardholder name _________________________________
5. Cardholder billing address ______________________
   _____________________________________________________ _____________________________________________________
6. I authorize [Company Name] to charge $________ USD to the credit card listed above
7. Card holder signature: (Must be in handwriting)

   ____________________________________________________

   Today's Date _______________________________________

8. Also remember to send us a visible copy of the credit card (back side), including signature panel.

[Company Name]
[Company Address]