Legal Templates
Credit Card Payment Authorization Form

Credit Card Payment Authorization Form for the United States

Credit Card Payment Authorization Form Template for United States

A Credit Card Payment Authorization Form is a legal document used in the United States that allows businesses to obtain formal permission from customers to charge their credit card for specified amounts. This document complies with federal regulations including the E-SIGN Act and PCI DSS requirements, providing protection for both the merchant and the cardholder while establishing clear terms for payment processing and authorization.

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What is a Credit Card Payment Authorization Form?

The Credit Card Payment Authorization Form serves as a critical document in modern commerce, particularly in scenarios requiring secure and documented payment arrangements. This form is essential for businesses operating in the United States that need to process credit card payments, whether for one-time transactions or recurring charges. It helps ensure compliance with federal regulations while protecting both merchants and cardholders. The document typically includes cardholder information, payment details, authorization terms, and security measures in accordance with PCI DSS standards.

What sections should be included in a Credit Card Payment Authorization Form?

1. Customer Information: Basic details of the cardholder including name, billing address, phone number, and email address

2. Payment Details: Credit card information including card type, card number, expiration date, and security code (CVV)

3. Authorization Statement: Express authorization for charging the card, including specific amount or calculation method

4. Terms and Conditions: Payment terms, processing timeframes, and general conditions of the authorization

5. Signature Block: Space for customer signature, printed name, and date of authorization

What sections are optional to include in a Credit Card Payment Authorization Form?

1. Recurring Payment Terms: Details of recurring payment arrangements including frequency, duration, and total number of payments

2. International Transaction Notice: Disclosure of foreign transaction fees and currency conversion terms

3. Cancellation Policy: Terms and procedures for canceling the payment authorization, including notice requirements

4. Data Security Statement: Information about how card data will be stored, protected, and used in compliance with PCI DSS

What schedules should be included in a Credit Card Payment Authorization Form?

1. Schedule A - Payment Schedule: Detailed breakdown of payment amounts, dates, and frequency for recurring payments

2. Schedule B - Privacy Policy: Detailed information about data handling, protection measures, and privacy compliance

3. Schedule C - Card Network Requirements: Specific requirements and terms from relevant card networks (Visa, Mastercard, etc.)

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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Jurisdiction

United States

Publisher

Genie AI

Document Type

Authorization Form

Sector

Legal Services

Cost

Free to use
Industries

E-SIGN Act: Federal law governing electronic signatures and records in commerce, ensuring legal validity of electronic authorizations

Electronic Funds Transfer Act (EFTA): Federal law establishing rights and responsibilities for electronic fund transfers, including credit card payments

Fair Credit Billing Act (FCBA): Federal law protecting consumers against unfair billing practices and establishing dispute resolution procedures

PCI DSS: Payment Card Industry Data Security Standard - Security requirements for organizations handling credit card information

FACTA: Fair and Accurate Credit Transactions Act - Regulations on handling sensitive payment information and identity theft prevention

Gramm-Leach-Bliley Act: Federal law requiring financial institutions to explain information-sharing practices and protect sensitive data

FTC Disclosure Requirements: Federal Trade Commission rules requiring clear disclosure of payment terms and conditions to consumers

State Electronic Authorization Laws: State-specific requirements for obtaining and maintaining electronic payment authorizations

Card Network Rules: Specific requirements from Visa, Mastercard, American Express, and Discover for payment processing and authorization

Data Security Requirements: Combined federal and state requirements for securing and protecting payment card information

Record Retention Rules: Requirements for maintaining authorization and payment records for specific time periods

Privacy Protection Requirements: Federal and state regulations governing the protection of consumer financial privacy and data

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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