Scribd
Upload
718 views1 page

Credit Card Authorization Form

This document is a credit card authorization form for Berkshire Notary Services that collects a customer's credit card information including card type, number, expiration date, billing zip code, cardholder name, and signature to authorize Berkshire Notary Services to charge the card for agreed upon purchases and save the information for future transactions on the account.

Uploaded by

Thomas Keeler
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
718 views1 page

Credit Card Authorization Form

This document is a credit card authorization form for Berkshire Notary Services that collects a customer's credit card information including card type, number, expiration date, billing zip code, cardholder name, and signature to authorize Berkshire Notary Services to charge the card for agreed upon purchases and save the information for future transactions on the account.

Uploaded by

Thomas Keeler
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

From the Office of 370 Fort Hill Avenue

Thomas A. Keeler Pittsfield, MA 01201


Berkshire Notary Services (413) 358.5104

Credit Card Authorization Form

If you wish to pay using a Credit Card, 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 Information

Card Type: ☐ Mastercard ☐ Visa ☐ Discover ☐ American Express


☐ Other: _____________________

Cardholder Name (as shown on card): ______________________________________

Card Number: ________-________-________-________

Expiration Date: ________/________/________

Cardholder Zip Code (from billing address) _______________

I, _____________________________ hereby authorize Berkshire Notary Services and its Subsidaries to charge
my credit card above for agreed upon purchases. I understand that my information will be saved to file for
future transactions on my account.

_______________________________________ ________/________/________
Signature Date Signed

_______________________________________
Printed Name

From the Office of Thomas A. Keeler Berkshire Notary Services 370 Fort Hill Avenue Pittsfield, MA 01201 (413) 358.5104

You might also like