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Client Payment Authorization Form

This document contains an authorization format for clients to confirm transactions made using credit cards on websites. The format requires the client's name, credit card number and expiration date, amount of the transaction in Indian Rupees and equivalent USD, website and purpose of payment, invoice details, date of birth, billing address, contact details, and a signature to verify the transaction with the bank using a copy of the credit card.

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Sonu Tiwari
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698 views1 page

Client Payment Authorization Form

This document contains an authorization format for clients to confirm transactions made using credit cards on websites. The format requires the client's name, credit card number and expiration date, amount of the transaction in Indian Rupees and equivalent USD, website and purpose of payment, invoice details, date of birth, billing address, contact details, and a signature to verify the transaction with the bank using a copy of the credit card.

Uploaded by

Sonu Tiwari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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This refers to the authorization format required from your clients as specified below:

I Mr./Ms. ______________________ hereby confirm having authorized a transaction by


my __________________________ MasterCard / Visa credit card number
_____________________ expiring at ________________ for Indian Rupees.
________________ (equivalent to approx USD $______________) vide the website
______________________________ towards payment for
___________________________________ as per their Invoice No._________________
dated _______________.
My Date of birth is ______________ and the Billing address for the above consignment
is _____________________________________________________. I can be contacted
on Telephone number _______________ & email address ____________________ for
the above verification.
I have also enclosed herewith front copy of my _______________________
Mastercard / Visa Credit Card so that my bank can get the above details verified.
Signature: _________________________________
Name: __________________________________

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