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Blank Credit Card Authorization Form

Blank Credit Card Authorization Form


A blank credit card authorization form is filled by a credit card holder to grant permission to a company or an individual to collect money, make purchases and other financial details on his or her behalf.  The authentication often refers to financial settlement of bills and purchases for a certain period of time.  At the end of the specified period, another form can be filled to authorize another financial transaction.

Blank Credit Card Authorization Template
Blank Credit Card Authorization Template

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Customer Information:

Name of the cardholder

Credit Card Information:

Sections to record the credit card details including:
Card type (e.g., Visa, Mastercard)
Account number
Expiration date
Billing address
CVV code (security code)


A section for the customer to sign and also print their name, authorizing the merchant to charge the specified amount to their credit card.

Merchant Information:

Some forms may include a space for the merchant to include their business name and also contact information.


Secure Transactions:

This form allows you to securely obtain a customer’s credit card information and authorization for a transaction without processing the payment directly through your point-of-sale system. This can be also helpful for situations where you cannot process a payment immediately, such as over the phone or by mail order.

Reduced Errors:

By having the customer fill out the form, you can reduce the risk of errors in the credit card information, which can lead to declined transactions and also delays.

Record Keeping:

The completed form provides a paper record of the customer’s authorization for the transaction, which can be also helpful for bookkeeping purposes or in case of any disputes.

Important Disclaimer: These templates are for informational purposes only. They are not a substitute for legal advice. Before using any template, consult with an attorney to ensure it meets your specific needs. EditableForms.com is not a law firm and cannot accept legal requests.