Authorization to Charge Credit Card Form - Microsoft
Authorization to Charge Credit Card Form AUTHORIZATION AGREEMENT –FOR PRE-ARRANGED PAYMENTS BY CREDIT CARD Name on Credit Card: I (we) hereby authorize : Rotary Club of Kerrville_________________________________________________________________________________________ hereinafter called COMPANY, to charge our credit card account indicated below. NOTE: The dollar amount showing due on the current Rotary bill will be charged to the account indicated below in accordance with the terms of said bill. Credit Card Name:Account NumberExpiration Date: C.I.D. Number (Back of Card): This authority is to remain in full force and effect until COMPANY has received written notification from me of its termination in such time and in such manner as to afford COMPANY a reasonable opportunity to act on it. . After account has been charged, I have the right to have the amount of an erroneous debit immediately credited to my account by Company, provided I send written notice of such entry in error to the Company within 15 days following issuance of the account statement. NAME (PLEASE PRINT) Date:SIGNATURE ................
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