Free template
Credit Card Authorization Template – Florida
Use this template when recurring billing, cancellation timelines, and customer change requests need clean, trackable documentation.
Downloaded 3620 times
Download template
Credit Card Authorization Template
1. Cancellation and Change Instructions
Cancellation Notice Email: [Billing or Support Email Address]
Cancellation Notice Mailing Address: [Billing Department Address]
Cancellation Effective After: [Number] business days from receipt of written notice
Charges Already Processed: [Charges processed or in progress before the effective time may still be applied]
2. Cardholder Information
Cardholder Name: [Cardholder Full Name (as it appears on the card)]
Billing Address: [Street Address], [City], [State/Province], [ZIP/Postal Code], [Country]
Phone: [Cardholder Phone Number]
Email: [Cardholder Email Address]
3. Business / Merchant Information
Business / Merchant Name: [Business / Merchant Name]
Business Address: [Business Address], [City], [State/Province], [ZIP/Postal Code], [Country]
Phone: [Business Phone Number]
Email: [Billing Email Address]
Website: [Website URL]
4. Card Details
Type of Card: [Select: Visa / Mastercard / American Express / Discover / Other: Card Type]
Card Number: [XXXX-XXXX-XXXX-XXXX]
Expiration Date: [MM/YY]
Security Code: [XXX]
Name of Issuing Bank: [Bank Name]
5. Authorization Type and Amount
Authorization Type: [Select: One-Time Charge / Recurring Charges]
Authorized Amount (one-time): [Amount and Currency]
Date of Charge (one-time): [Date]
Recurring Charge Amount (if recurring): [Amount and Currency]
Billing Frequency (if recurring): [Weekly / Monthly / Quarterly / Annually / Other]
First Charge Date (if recurring): [Start Date]
Final Charge Date or Until Cancelled (if recurring): [End Date or “Until Cancelled”]
Maximum Amount Per Billing Period (if applicable): [Maximum Amount and Currency]
6. Goods and/or Services
Description: [Brief Description of Goods and/or Services]
Related Invoice / Order / Account Number: [Reference Number]
7. Authorization and Agreements
Charge Authorization: [Cardholder authorizes Business / Merchant Name to charge the card listed for the amounts and schedule stated]
Authorized User Confirmation: [Cardholder confirms they are the authorized cardholder or authorized user]
Statement Descriptor: [Descriptor / Business Name as it appears on card statements]
Billing Information Updates: [Cardholder will promptly communicate changes to card details or billing information]
8. Cancellation Request Log Table
Log entries: [Use this table to track stop-billing requests for recurring charges]
Date Received | Request Channel | Effective Date | Processed By | Internal Reference |
[MM/DD/YYYY] | [Email/Mail/Other] | [MM/DD/YYYY] | [Staff Name/ID] | [Customer ID/Ticket ID] |
[MM/DD/YYYY] | [Email/Mail/Other] | [MM/DD/YYYY] | [Staff Name/ID] | [Customer ID/Ticket ID] |
[MM/DD/YYYY] | [Email/Mail/Other] | [MM/DD/YYYY] | [Staff Name/ID] | [Customer ID/Ticket ID] |
9. Internal Notes
Customer ID: [Internal Reference / Customer ID]
Notes: [Internal Notes]
10. Cardholder Signature
Cardholder Signature: [Signature]
Printed Name: [Cardholder Full Name]
Date: [Date]
Business Receipt Acknowledgment: [Staff Name/ID / Date Received]
Flash deal
Flash deal
Today
Today
No time to fill it up? Generate your custom agreement with AI Lawyer in seconds
What’s Included
Legal Research
Legal Research
Legal Research
Contract Drafting
Contract Drafting
Contract Drafting
Document Review
Document Review
Document Review
Risk Analytics
Risk Analytics
Risk Analytics
Citation Verification
Citation Verification
Citation Verification
Easy-to-understand jargon
Easy-to-understand jargon
Easy-to-understand jargon
Details
Learn more about
Credit Card Authorization Template – Florida
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Florida Credit Card Authorization Template FAQ
Why put cancellation details at the top of the form?
For recurring billing, customers often care most about how to stop charges and when the stop becomes effective. Placing the cancellation channel and processing window first reduces confusion and makes it easier for customers to find the right contact. It also helps customer service teams because the form becomes a shared reference when someone asks about a cancellation timeline or whether a charge was already in progress.
How do I choose an effective cancellation window?
Pick a processing period that matches how your billing runs and how quickly requests can be verified and routed internally. The window should be long enough to handle operational steps but short enough to feel reasonable to customers. Whatever period you use, apply it consistently and capture the date received so there is a clear record of when the request started.
What should a customer include in a written cancellation notice?
A cancellation notice should identify the account or subscription and provide enough information for the business to locate the authorization, such as a customer ID, invoice reference, or last four digits of the card if your process allows. Customers should also state whether they are canceling future charges only or requesting other changes. The form helps by listing the correct address and email for notice delivery.
Can a business continue charging after a cancellation notice is sent?
The form’s effective-date language is intended to explain that charges already processed or in progress may still be applied. This is a practical reality of billing cycles and processing cutoffs. The safest approach is to document the date received, apply the stated window consistently, and confirm the change in your internal system using a logged reference so both sides can track what happened.
How do I handle charge questions when the customer does not recognize the descriptor?
Use a descriptor field that matches what the customer will see on the statement. If your marketing name differs from the processing name, capture both through the descriptor placeholder. When a question comes in, you can point back to the signed authorization that lists the descriptor and the referenced invoice or account. That reduces the likelihood of escalation and supports quicker resolution.
Is an email authorization acceptable if the customer cannot sign?
Many businesses document consent through a combination of communications, such as an email approval paired with an invoice reference, but your process should make the authorization method clear and retrievable. If you rely on email, store it with the same internal reference as the authorization form. The key is that the record shows what was authorized, by whom, and on what terms, so the consent is not ambiguous.
Should I keep a separate log for cancellations?
A cancellation log is useful when you have multiple recurring customers or multiple staff members processing requests. It creates a simple audit trail showing when requests were received, how they were delivered, and when they became effective. This can reduce internal errors and make customer communications more consistent. Even a short log tied to an internal reference can prevent repeat questions about status.
Similar templates
Other templates from
Financial Agreements
Money back guarantee
Free trial
Cancel anytime
AI Lawyer protects
your rights and wallet
Money back guarantee
Free trial
Cancel anytime
AI Lawyer protects
your rights and wallet
Money back guarantee
Free trial
Cancel anytime
AI Lawyer protects
your rights and wallet
Money back guarantee
Free trial
Cancel anytime