Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results

Sign UpLogin With Facebook
Sign UpLogin With Google

Credit Card Authorization Form Template

Streamline Payment Processes with This Simple Template

Struggling to secure payment information safely can leave your business vulnerable. This Credit Card Authorization Form template is designed for small business owners like you, helping you confidently collect customer payment details while ensuring compliance. Enjoy the ease of direct, secure payment processing, maintain clear documentation for your records, and enhance customer trust, all while keeping your forms user-friendly and compliant with WCAG standards. Take a glance at our live template!

Business or merchant name
Billing contact email
Invoice or reference number
Cardholder full name
Cardholder email
Cardholder phone
Billing address (street, city, state/province, postal code, country)
Authorization type
One-time charge
Recurring payments
Authorized amount (enter currency amount)
Currency (e.g., USD, EUR, GBP)
Charge description or reference (what this charge is for)
If recurring, select the billing frequency
Weekly
Every 2 weeks
Monthly
Quarterly
Annually
Not applicable (one-time)
Recurring start date
Recurring end date (leave blank if until canceled)
Name on card
Card last 4 digits
Card expiration (MM/YY)
Card type
Visa
Mastercard
American Express
Discover
Other
Please Specify:
Do you authorize the merchant to charge the card as described above?
Yes
No
I certify that I am the authorized cardholder for the card referenced above.
True
False
I have read and understand the refund and cancellation policy.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Type your full name as your electronic signature
Signature date
I consent to use electronic records and signatures for this authorization.
Yes
No
{"name":"Business or merchant name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Business or merchant name, Billing contact email, Invoice or reference number","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration representing a credit card authorization form template for FormCreatorAI article

When to use this form

Use this form when you need your customer to approve a card charge without a terminal. It works for phone or email orders, deposits, no-show or damage fees, subscriptions, and keeping a card on file. You save time, reduce disputes, and get clear consent tied to a purchase. For a single payment, pair it with the Credit card transaction form . For invoices or ongoing services, connect it to your Bill pay form , or start with an Invoice request form to capture what the customer owes. If your team reconciles totals each day, the Daily remittance entry form helps match signed approvals to deposits.

Must Ask Credit Card Authorization Questions

  1. Whose card are you authorizing, and what is their relationship to the purchase?

    This verifies the cardholder's identity and authority to approve the charge, reducing disputes. It also tells you who to contact if you need to resolve a refund or chargeback.

  2. What total amount are you authorizing, and in which currency?

    Stating a clear cap and currency prevents overbilling and foreign exchange surprises. It documents exact consent if the bank asks for proof.

  3. Is this a one-time charge or recurring billing? If recurring, list frequency, start date, and end date or max total.

    This sets expectations and keeps you compliant with card network rules. It also lets you collect only what was approved.

  4. Which invoice, order, or service does this authorization cover?

    Linking the charge to a specific deliverable strengthens your records in case of a dispute. For higher deposits or large orders you review, the Financial statement form can support your approval process.

  5. What is the cardholder's billing address and contact info (name, phone, email)?

    Address Verification Service (AVS) checks reduce fraud and declines. Accurate contact details ensure receipts and notices reach the right person.

More Forms

Copy/Edit Form Send to Recipients Make a Form w/AI Form Builder Must Ask Questions
  • 100% Free - No Catches
  • Collect Responses Today
  • Tailor to your Look & Feel