Credit Card Authorization Form
Your completion of this authorization form helps us protect you, our valued customer, from credit card fraud. All information
entered on this form will be kept strictly confidential within RingCentral. Please check your requested transaction:
D New account activation from an IP address outside of the United States
D Enabling International calling from your account
D Activating more than two accounts on one credit card
D Activating higher-end auto-purchase amounts
D Raising the Transactions or $ Amount Limit per month for your account
D Activating Fax Broadcasting in your account
D Other ------------------------------
Instructions:
1. Complete all the fields on this page, including your signature at the bottom.
2. On the next page make a copy of the front and back of your credit card and your driver's license or passport. For your
protection, please follow the instructions below regarding personal information:
• Credit Card Instructions: Cover the middle numbers on the front of your credit card allowing visible only the first 6
and last 4 (see image below). Also, cover the CVV (card security code) located on the back of MasterCard, Visa card,
Discover card, and on the front for AmEx card (see image below).
• ID/Passport Instructions: Cover your Identification Number and Date of Birth, allowing visible only your Full Name
and Expiration Date.
3. Fax both pages of completed form to (800) 520-1568 or (650) 641-2698. Please note:
• Faxes coming in with blocked caller IDs will NOT be processed.
• Do NOT email this form.
4. RingCentral will receive the fax, and, upon satisfactory review of the information on this form, complete the requested
transaction, which can take up to 48 hours to process.
Credit Card Holder and Billing Address:
First Name: ---------------------------------------------------------------
Last Name: ---------------------------------------------------------------
Address 1: ----------------------------------------------------------------
Address 2: ----------------------------------------------------------------
City: -------------------------------------------------------
State: --------------------------
Zip: ---------------
Country: ----------------------------
Contact Phone #: -----------------------------------------------------------
RingCentral Phone#: ---------------------------------------------------------
I, the undersigned, hereby acknowledge and agree to pay all charges from "RINGCENTRAL INC". I understand it is my sole
responsibility to monitor the activity on my Credit Card and further agree that, in the case of a dispute, I will resolve the
matter directly with RingCentral, Inc.
----------------------------------------------- ----------------------
Authorized Signature of Card Holder Date
Form Date 01/20/19
Credit Card & ID Copies
Make a copy of your Credit Card in the spaces below. Use a light setting on your copy machine to ensure the card number
and name are visible. Cover the middle numbers on the front of your credit card. Illegible images will not be accepted.
Note: The Credit Card number below must match the Credit Card number on file in your RingCentral account
Front of your credit card Back of your credit card
(Visa, MasterCard, Discover, American (Visa, MasterCard, Discover, American
Express) Express)
PRINT only the first 6 and the last 4 digits of COVER THE CVV Number
For Visa, Mastercard, and Discover the CVV numbers are the 3 digits
that appear at the end of the credit card number on the back of the
the Credit Card: ----------------- ----------- card. For AMEX, it's the 4 digit code appearing on the front of the card.
Copy your driver's license or passport in the space below
Current driver's license or passport
Form Date 01/20/19
Examples:
Front of Visa/MasterCard/Discover
Front of AmEx Credit Card
Cvv
Form Date 01/20/19
