Free credit card authorization form template 26Free credit card authorization form template 26
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123 Park Avenue, Michigan 69789 MI
123-456-7899
Event Date:
Event Theme:
Room:

Even Time:
# of Guests:
Menu:

Credit Card Authorization Form
I authorize COMPANY NAME to bill the credit card below as the method of payment to cover the
following charges as stated below:
□ Food

□ Beverages

Organization / Name of Group:
Type of Credit Card:
Credit Card Number:
Cardholder Name:
Billing Address:
City:
Tel:

□ Deposit

□ Room

□ All Charges

Expiry Date:

State:
Email:

Zip:
Fax:

Signature of Cardholder:
Date:

On-site contacts authorized to sign
1)
2)
Please complete the form (include photocopies of both front and back of your credit card) and
fax the completed form and the copies to (123) 123-4567 to place your order.

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