Credit Card Authorization Form Church - Clover Sites
CREDIT CARD PAYMENT AUTHORIZATION Cardholder Name: Cardholder Address: Child(ren) Name(s): Phone/Email:
Credit Card Number: Expiration Date: CCV Number:
$________________
One Time Charge
Recurring Monthly on the 1st
I hereby authorize ChristChurch Presbyterian to charge my credit card in the amount listed above. Recurring charges: I agree that the effective date of each charge will be the same as the date indicated above. This authority is to remain in full force and effect until ChristChurch Presbyterian has received written notification from me of its termination in such manner as to afford ChristChurch Presbyterian and its own financial institution a reasonable opportunity to act on it.
AGREED on this __________ day of ____________________________________, 20__________ ________________________________________
Signature
rev. 04/03/2017
________________________________________
Printed Name
Credit Card Number: Expiration Date: CCV Number:
$________________
One Time Charge
Recurring Monthly on the 1st
I hereby authorize ChristChurch Presbyterian to charge my credit card in the amount listed above. Recurring charges: I agree that the effective date of each charge will be the same as the date indicated above. This authority is to remain in full force and effect until ChristChurch Presbyterian has received written notification from me of its termination in such manner as to afford ChristChurch Presbyterian and its own financial institution a reasonable opportunity to act on it.
AGREED on this __________ day of ____________________________________, 20__________ ________________________________________
Signature
rev. 04/03/2017
________________________________________
Printed Name
