CREDIT CARD AUTHORIZATION FORM
ONE-TIME PAYMENT AUTHORIZATION, By completing and signing this form, you authorize Wasatch Bath to charge your credit card for the amount indicated. This authorization is for a single transaction only and does not provide permission for any additional charges.
Cardholder Information (as it appears on card)
First Name
Last Name
Phone Number
Email Address
Address
Street Address
City
State / Province
Postal / Zip Code
Transaction Description
Downpayment Amount
3% Credit Card Fee
Authorized Transaction Amount
Should be Empty: