Credit Card Authorization Form

Frieda Marroquin, a franchised Chick-fil-A Operator

Eldorado & Tollway FSU | 5211 Eldorado Parkway, Frisco, TX 75033

Lebanon & Tollway FSU | 5377 Dallas Parkway, Frisco, TX 75034

Contact: catering@cfafrisco.com

SIGNATURE ON FILE AND CREDT CARD BILLING AUHTORIZATION FORM

The information in this document is encrypted at the point of entry and is only accessible to the Operator, designated staff, and credit card processing agencies. More information can be found here.

If you would prefer to complete the form and email it to the catering team, click the link below and email the completed form to catering@cfafrisco.com.

Credit Card Authorization Form (PDF)

CARD TYPE*

NAME AS WRITTEN ON CARD*

First NameLast Name

COMPANY NAME (if applicable)

Card Number*

Expiration Date*

CVV Code*

3 or 4 digits

PHONE NUMBER OF CARDHOLDER*

Please enter a valid phone number.

EMAIL OF CARDHOLDER*

example@example.com

AGREEMENT

This Signature on File Credit Card Billing Authorization Form (the “Authorization Form”) is provided to Frieda Marroquin, the franchised Chick-fil-A Operator at Eldorado & Tollway FSU and Lebanon & Tollway FSU (the “Operator”) upon the request of and as a convenience to the cardholder. The cardholder acknowledges that the charges submitted pursuant to this Authorization Form will not bear the cardholder’s signature or an imprint of the credit card. To the extent any charges are authorized to be charged to the credit card listed above but are declined or subsequently rejected, the cardholder agrees to make restitution for such charges upon request from the Operator.

The Eldorado & Tollway FSU and Lebanon and Tollway FSR business operated by Operator is an independently owned and operated franchised business. By executing and delivering this Authorization Form, the undersigned cardholder hereby authorizes Operator, and Operator’s credit card processing agents, to collect and process the above credit card information on this Authorization Form for consumer products and services rendered by Operator pursuant to a telephone order.

Changes/Cancellations

Abandoned Orders: Orders that are not picked up and are not cancelled within an acceptable timeframe will be subject to a 50% charge of the order total.

Pickup Cancellation: Pickup orders can be modified or cancelled up to 30 minutes prior to the scheduled pickup time without a penalty.

Delivery Cancellation: Delivery orders can be modified or cancelled up to one hour prior to the scheduled delivery time without a penalty. Delivery orders that have been dispatched (assigned to a driver and left the store) will be charged the full cost of the order.

SIGNATURE OF CARDHOLDER*

PRINTED NAME OF CARDHOLDER*

First NameLast Name

DATE OF SIGNATURE*

Date

Privacy Statement for Signature on File Customers

Operator offers customers interested in the convenience of placing orders by telephone an opportunity to complete this “Signature on File” form authorizing Operator, and Operator’s credit card processing agents, to charge the cardholder’s credit card without the necessity of an additional signature for each transaction. This Authorization Form is offered entirely as a convenience to the undersigned cardholder and is not required.

Operator, and Operator’s credit card processing agents will store all credit card information received from cardholders in a secure and private environment and will not knowingly disclose such information to any third party without the written consent of the cardholder other than as required to process payment or to comply with law.

Operator, and Operator’s credit card processing agents will only use the credit card information provided as is necessary to complete the transactions requested by the cardholder.

Cardholder may revoke the authorization contained in this Authorization Form at any time by providing Operator with written request thereof at the physical or email address set forth above.