Credit Card Authorization Form

One Time Payment($2,000.00 one-time payment)

Monthly Payment($20.00 for each month)

Quarterly Payment($60.00 for each three months)

Yearly Payment($240.00 for each year)

Payment Method
Credit	Express

ConditionText
I, {cardholderName}, as a cardholder, hereby authorize ABC Company to charge my credit card for {conditiontext} and confirm that the information for the credit card and billing address is complete and accurate.

I have been informed that I can cancel the recurring payment at least 15 days before the payment by phone or signing a consent form provided by the merchant company.
Date

MonthDayYear
Date
Cardholder Signature

Clear
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