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2 Divas CC Authorization

2 Divas Travel is requesting authorization for a one-time credit card payment from a customer. The customer must provide their credit card information including name, card number, expiration date, CVV code, billing address and phone number. By signing the form, the customer allows 2 Divas Travel to charge the specified amount on or after the listed date for the described goods or services. This authorization is only valid for a single transaction between the two parties.

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176 views1 page

2 Divas CC Authorization

2 Divas Travel is requesting authorization for a one-time credit card payment from a customer. The customer must provide their credit card information including name, card number, expiration date, CVV code, billing address and phone number. By signing the form, the customer allows 2 Divas Travel to charge the specified amount on or after the listed date for the described goods or services. This authorization is only valid for a single transaction between the two parties.

Uploaded by

api-266572515
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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7715 Crittenden Street, #329

Philadelphia, PA 19118-4421
267-974-7077 (P)

One Time Credit Card Payment Authorization Form

Sign and complete this form to authorize 2 Divas Travel to make a one time debit to your
credit card listed below.

By signing this form you give us permission to debit your account for the amount indicated
on or after the indicated date. This is permission for a single transaction only, and does not
provide authorization for any additional unrelated debits or credits to your account.
Please complete the information below:
I ____________________________ authorize 2 Divas Travel to charge my credit card
(full name)

account indicated below for _____________ on or after ___________________. This payment is for
(amount)

(date)

_____________________________________.
(description of goods/services)

Billing Address ____________________________


City, State, Zip ____________________________

Account Type:

Visa

MasterCard

Phone# ________________________

Email ________________________

AMEX

Discover

Cardholder Name _________________________________________________


Card Number

Expiration Date

_____________________________________________
____________

CVV2 (3 digit number on back of Visa/MC, 4 digits on front of AMEX) ______

SIGNATURE

DATE

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined
above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for
one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card
company; so long as the transaction corresponds to the terms indicated in this form.

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