Free template
Credit Card Authorization Template – Washington
Use this template to manage recurring billing with approved contacts, defined confirmation channels, and clean documentation for updates and cancellations.
Downloaded 4413 times
Download template
Credit Card Authorization Template
1. Authorized Contacts and Communication Preferences
Primary Authorized Contact: [Name / Role / Email / Phone]
Secondary Authorized Contact: [Name / Role / Email / Phone]
Preferred Confirmation Method: [Select: Email / Text / Portal message / Other]
Customer Support Contact: [Support Email / Support Phone]
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. 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]
5. 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]
6. Goods and/or Services
Description: [Brief Description of Goods and/or Services]
Related Invoice / Order / Account Number: [Reference Number]
7. Cancellation and Change Routing
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
Change Request Channel: [Select: email to billing / portal request / support ticket / other]
8. 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]
9. Authorized Contact Table
Contacts: [List individuals permitted to request cancellations or billing changes]
Name | Role/Relationship | Email/Phone | Permitted Requests |
[Name] | [Role/Relationship] | [Email/Phone] | [Select: cancel / update card / update billing contact / request receipts] |
[Name] | [Role/Relationship] | [Email/Phone] | [Select: cancel / update card / update billing contact / request receipts] |
[Name] | [Role/Relationship] | [Email/Phone] | [Select: cancel / update card / update billing contact / request receipts] |
10. Confirmation and Evidence Index
Confirmation Sent Via: [Select: email / text / portal message / none]
Confirmation Identifier: [Message ID / ticket ID / screenshot link / file name]
Record Storage Location: [Folder path / system name / link]
11. Signatures and Review
Cardholder Signature: [Signature]
Printed Name: [Cardholder Full Name]
Date: [Date]
Business Account Owner Review: [Name / Title / Signature / Date]
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 – Washington
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.
Washington Credit Card Authorization Template FAQ
Why list authorized contacts on a credit card authorization form?
Some customers prefer that a finance lead, office manager, or designated contact handle billing changes and cancellations. Listing authorized contacts creates clarity about who can request updates and how those requests should be routed. This reduces delays and prevents confusion when a person other than the cardholder reaches out. It also supports recurring billing by making change management predictable and easy to track.
How do I confirm a recurring charge schedule to the customer?
Confirm the amount, frequency, start date, and end condition in writing using the preferred confirmation channel, such as email or a portal message. If the charge dates vary, provide a simple schedule or reference list and link it to the authorization’s reference number. Keeping a confirmation identifier, such as a message ID or ticket ID, makes it easier to show what was communicated and when.
What is the best way to handle change requests for billing frequency or amount?
Treat changes as a separate approval event. Document the requested change, the effective date, and the updated terms, and confirm who approved the update. If multiple contacts are permitted to request changes, use the authorized contact table so staff can verify that the request came from a permitted person. AI Lawyer can help you standardize a change-record format so updates are captured consistently.
Do I need to include both email and mailing address for cancellations?
Including both gives customers a clear path regardless of their preferred communication method. It also ensures there is a defined channel for written notice and reduces confusion about where to send requests. The form should also state the processing window so customers know when the cancellation takes effect and what may happen if a charge is already in progress.
How should I describe goods or services for subscription billing?
Use a description that identifies the subscription or service category and ties it to an account or membership reference. Customers often recognize the account identifier more easily than internal product names. If there are tiers or add-ons, consider including the plan name in the description field. The goal is to make the charge recognizable on a statement and easy to reconcile internally.
What if the customer says they never received a receipt or confirmation?
Use the confirmation index fields to record how confirmations are delivered and the identifier for each message. If the customer’s email changes, update the contact record and keep the internal reference consistent so receipts can be resent reliably. A clear communication pathway reduces billing friction and helps customers resolve questions before they escalate to disputes.
Is a credit card authorization form the same as storing a card on file?
Not necessarily. An authorization form documents permission to charge under specific terms, while “card on file” describes a payment method that may be used for future charges. The two often overlap in recurring billing, but the important difference is that the authorization should define the amount, schedule, and cancellation process. Clear terms make it easier for both parties to understand what future charges are within the consent granted.
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