Recurring Credit Card Payment Authorization Form

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The recurring credit card authorization form is a document which allows an individual to give authority to a company/merchant to regularly charge their credit card on the days specified within the form. These recurring payments allow the cardholder to pay their bills automatically, thus avoiding the hassle of paying regularly online and allowing the cardholder to dodge any potential late fees and service charges. The card details must be specified within the form including the number, account holder name, expiration date, CVV, and zip code. While the most common frequency of payment is monthly, the below form allows the cardholder to customize the frequency of charges to the services for which they are paying.

How to Write

Step 1 – Download the authorization form in either Adobe PDF or in Microsoft Word (.docx).


Step 2 – Read over the opening paragraph as it explains the terms of the form and what it is you’re agreeing to. Next, the following data must be submitted:

  • Your Name
  • Merchant’s Name
  • Amount the Credit Card in question will be charged
  • Day that the Credit Card will be charged
  • Frequency (month, week, year, etc.)

Step 3 – The billing information must be supplied next including the billing address, your phone number and your email address. Next, provide the card details indicating the type of card (Visa, MasterCard, Discover, American Express), the Cardholder Name, the Account/CC Number, the Expiration Date, the CVV, and the Zip Code.

Step 4 – Read over this paragraph as well before entering in the name of the merchant once again. Provide the date, print off the form, and enter your signature in the applicable field.