Credit Card Authorization Form Clause Samples

Credit Card Authorization Form. For your convenience, we will use this authorization to charge your credit card account for your advance orders and any additional amounts incurred as a result of show site orders placed by your representative. For Third-Party pay- ers please use “Third Party Billing Agreement” form. Please complete the information requested below: Visa Master Card American Express Personal Company Card Number: Exp. Date: Card Holder’s Name (Print) Signature: CVV: City: State: Zip: • Please make all checks payable to: AGS Exposition Services, Inc. • All checks must be in U.S. currency. Check Number: • Please print show name and booth number. • Company checks must be received 14 days prior to exhibitor Amount Due: move-in to provide adequate time for processing • Orders are processed and appropriate discounts (if any) are applied on the date that your payment is received. A copy of your check by email, fax, etc. is not considered payment. • Credit Card Authorization MUST be on file with AGS Expo Services before any goods or services are rendered regardless of your preferred method of payment. AGS Expo Services • ▇▇▇▇ ▇▇ ▇▇▇▇ ▇▇▇▇▇▇ • Orlando, FL 32811 As an exhibitor electing to use a third-party for my billable services, I understand and hereby agree that the ultimate responsi- bility for payment of all charges is mine. Further, I agree to be bound by all terms and conditions outlined in the Payment Terms and Conditions within this Exhibitor Service Manual. In the event that the named third-party fails to meet the required payment terms, charges will revert back to me, the exhibiting company. All invoices are due and payable upon receipt, by either party. Payment in full must accompany your order. Please note, we will use this authorization to charge your credit/debit card account for all orders noted above, at anytime, including those placed onsite by your representative. These charges may include all services provided by AGS Expo Services including but not limited to material handling, labor, and product orders. For tax-exempt status, within the state of the event, please submit a tax- exempt certificate. We gladly accept VISA, MasterCard and American Express. Credit Card Number: Exp. Date: Card Holder’s Name: CVV: Signature: Credit Card Billing Address: City: State: Zip: AGS Expo Services • ▇▇▇▇ ▇▇ ▇▇▇▇ ▇▇▇▇▇▇ • Orlando, FL 32811 AGS Expo Services has established the following terms and conditions of sale and rental for all services rendered by AGS to all clients, exhib...

Credit Card Authorization Form. I hereby authorize NME Surveillance LLC to charge my credit card for: • Start-up fees; • Alarm Monitoring Service(s) • Alarm Installation and Equipment; • Service Call Charges and Alarm Components; • Programming Changes; • Requested reports; • Recovery Charges of Proprietary Account Data Belonging NME Surveillance LLC; □ Visa □ MasterCard □ American Express (add 3%) Cardholder: Credit Card billing address: Expiration date: Email address for electronic receipt: Authorized Signature:

Credit Card Authorization Form. Note: Only fill out the following information if you are paying with a credit or debit card.

Credit Card Authorization Form. Gunston Hall requires all Contracting Parties to complete a $500 credit card authorization form that will only be used in case of damages to the event space or historic grounds. I, , herby authorize Gunston Hall to charge my credit card account in an amount not to exceed: $500. ( ) VISA ( ) MasterCard ( ) American Express ( ) Discover Credit Card Number: Expiration Date: / CVV Code: Cardholder Name: Street Address: City: State: Zip Code: A deposit in the amount of half the rental fee is due with a signed Facility Rental Agreement at the time of booking to secure the date of the event. The remaining balance of the rental fee plus any additional fees are due 30 days prior to the event. Payment must be in the form of cash or check, made payable to Gunston Hall. All Contracting Parties are required to complete a $500 credit card authorization form. This gives Gunston Hall the right to use any or all of the amount towards cleaning and repair of the rental space or any property located in or on the premises belonging to Gunston Hall. If the Contracting Party has caused no damage, and the premises is in the condition the Contracting Party found it prior to the event, as determined by Gunston Hall, the $500 form will be retained for 10 days then shredded. Gunston Hall will not charge any amount to a Contracting Parties credit card without notification. If damages and cleaning costs exceed $500, the Contracting Party shall pay Gunston Hall the amount owed for such damages and/or cleaning within 10 days of the date of the invoice from Gunston Hall.

Credit Card Authorization Form. As a Client of Premier Office Suites, LLC, (“Premier”), I , authorize Premier to charge the credit card listed below, for any and all fees associated with the Services outlined in the Virtual Office Services Agreement.

Credit Card Authorization Form. Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until canceled.

Credit Card Authorization Form. I hereby authorize ▇▇▇▇▇▇ ▇▇▇▇▇, MA, LPC-Intern to maintain a record of my credit card and my signature on file for payment of the following services: psychotherapy services, including deductibles, co-pays, non-cancelled or late- cancelled appointment fees, any charges owed that are not covered by my insurance company, and the litigation policies that are set forth in the Informed Consent Agreement. These charges include, but are not limited to, payment of retainer for court/deposition/legal proceeding preparation and appearance, consultation and telephone appointments, report and letter writing, and completion of disability paperwork. My signature below authorizes ▇▇▇▇▇▇ ▇▇▇▇▇, MA, LPC-Intern to charge my credit card for all applicable charges on an on-going basis. I understand that if I decide to terminate services with ▇▇. ▇▇▇▇▇, and my account is paid in full upon termination, I may withdraw the authorization to charge my credit card in the future. In the event your credit card expires, or is lost or stolen, of if you desire to use another credit card, please notify us and we will have you complete a new Credit Card Authorization Form, and will shred your old information. We are equipped to utilize Health Savings Account cards, and accept MasterCard, Visa, Discover and American Express. Client Name: Cardholder’s Name (as it appears on the credit card): Credit Card Billing Address (the address where the credit card statement is received) Street Apt/Suite City and State Zip Code Credit Card Type Visa MasterCard Discover AMEX

Credit Card Authorization Form. 2020-2021

Credit Card Authorization Form. As a Client of ViewPointe Executive Suites, LLC (“ViewPointe”), I, , authorize ViewPointe to charge the credit card listed below, for any and all fees associated with the Services outlined in the Virtual Office Services Agreement.