Credit Card Authorization Form

Credit/ Debit Card Number

Expiration Date

CCV (3 or 4 digits on the back)

Cardholders Name

BIlling Address

Apt, Suite, or Unit #

City, State, Zip Code

Amount to Charge

The total charge amount will vary based on the services provided and any purchases required for your daily operations. No charges will be processed without your prior authorization. Each charge will be a one-time transaction unless otherwise specified on the authorization form.

By signing this form, you authorize Shawana Campbell, Owner of Topaz Business and Tax Solutions, to charge the card listed above for the agreed-upon amount to complete the necessary purchase.

Cardholder's Signature

Today's Date