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Fillable Form Credit Card Authorization

A credit card authorization form is a document, signed by a cardholder, giving a merchant or other entity permission to charge a specified amount to that card.


What is the Credit Card Authorization Form?

The credit card authorization form allows a third party to make a payment on behalf of the cardholder by using the person’s consent and credit card information. Filling up this form is a common procedure when you have to authorize a subscription such as gym memberships, monthly rent, etc.

This form may be used in any of the following circumstances:

  • The credit cardholder is not physically present. The order or purchase may have been placed on the Internet, over the phone, via email, or by standard mail.
  • Credit card billing occurs in the future usually happens in hotels and car rental companies where an initial temporary charge is needed.
  • Credit card payments that are of an ongoing or recurring nature

A credit card authorization form is one way to protect yourself against fraud or unauthorized transactions. Aside from protecting the consumers, it also protects the businesses providing services.

The credit card authorization form also serves as proof that the cardholder has enough funds to cover for the transaction to be made. Therefore, the user needs to fill in all the important details for verification of funds.

If you will use a credit card to make the payment, then the details about the card are procured by swiping the credit card at the cash counter. By swiping the card the entire set of details appear instantly. In the case of the credit card authorization form, the form containing the details about the card and the transaction is sent to the concerned company.

How to fill out the Credit Card Authorization Form?

Instructions for this simple and basic form is directed for the cardholder.

Cardholder Name
Provide the name of the cardholder as shown in the card.

Billing Address
Enter the billing address of the cardholder

City, State & ZIP
Provide the city, state, and zip code of the cardholder’s billing address.

Credit Card Information
Provide all required credit card information.

Card Type
Select the type of card where the transaction will be made (VISA, Mastercard, Discover, or AMEX). If not listed, select “Other” and enter the type of card on the space provided.

Card Number
Enter your card number.

Expiration Date
Provide the date of the expiration of the card to be used for the transaction.

Security Code/CVC2/CVV2
Enter the security code of the card to be used for the transaction.

Amount to Charge
Provide the authorized amount to charge in dollars on the space provided.

To provide proof of your approval, the Authorization Statement presented should be completed. Enter the name of the person you are giving authority to charge your credit card.

Provide your signature as proof of authorization.

Enter the date you signed and completed the authorization form.


This form is usually filled out in person after making a purchase. It is also possible for a company to ask you to send it via email however, remember to validate the business you are transacting with to ensure that your details will not be used for other purposes.


  • By filling out this form, you are allowing the business owners to securely store your payment information. This makes it easier for them to charge you especially if you are a recurring customer.
  • In other forms, the period for how long the authorization lasts indicated. For this specific form, the authorization is just for a specific amount of money. If you'll sign an authorization form granting permission to the business to charge your card repeatedly. You'll be charged on the date listed on the agreement you signed until you cancel the membership or subscription.
  • If you are making a purchase online, you don't have to sign an authorization form. The moment you entered your information, you are consenting to the purchase.
  • If your credit card was charged without your express permission, you'll have to take the issue up with the business first. If the business is unwilling to remove the charge, you may initiate a dispute with your card company.
  • If you are a person purchasing on the cardholder’s behalf, keep in mind that there are stores that may ask for identification to prove that it's his credit card. Make sure to bring one to complete the purchase with the card. Such measures are done because signing another person's name for a credit card purchase can constitute illegal forgery.
  • A portion of the authorization states that the company may keep the details. Therefore, it is important to be aware of the laws regarding the collection and retention of the credit card information. These laws vary from state to state. The Payment Card Industry Data Security Standards (PCI DSS) is a proprietary security standard created to provide a way of measuring and maintaining security practices in organizations that handle cardholder information. You may ask the company if they comply with the PCI standards before giving out information.
  • There are other types of credit card authorization form that you may find online. This template contains the essentials such as the cardholder’s details, credit card details( Credit card type e.g. Visa, Mastercard; credit card number, expiry date, and CVV security code), an authorization statement, and the cardholder’s signature.
  • If you will be making an order or purchase that is recurring, it’s best to fill out a form that asks for the following: transaction amounts, frequency of the charges, and the duration for which cardholder permission is granted.
  • For merchants or business owners, it is best to always keep the authorization forms as long as the charge is still being made for future reference. In credit card concerns, the costs usually fall heavily on the merchants. This reason alone can justify why there is a great need to require credit card authorization forms.
  • For merchants or business owners, design your form to suit the sector you are in whether you are in the business sector, healthcare, hospitality, or legal services.

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