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  • Xactus Credit Card Authorization

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    Zylucシ
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    This credit card authorization form collects information such as name, account number, expiration date, billing address and security code from the cardholder. It also requests additional personal information including phone number, date of birth, marital status, home address and social security number. By signing, the cardholder authorizes a credit reporting agency to charge $49.09 to the provided credit card.

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    This credit card authorization form collects information such as name, account number, expiration date, billing address and security code from the cardholder. It also requests additional personal information including phone number, date of birth, marital status, home address and social security number. By signing, the cardholder authorizes a credit reporting agency to charge $49.09 to the provided credit card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    29 views1 page

    Xactus Credit Card Authorization

    Uploaded by

    Zylucシ
    This credit card authorization form collects information such as name, account number, expiration date, billing address and security code from the cardholder. It also requests additional personal information including phone number, date of birth, marital status, home address and social security number. By signing, the cardholder authorizes a credit reporting agency to charge $49.09 to the provided credit card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Credit Card Authorization Form

    Name on the Card: _____________________________________________________________________

    Type of Card: Visa MC AmEx Discover Other _____________________

    Account Number _________________________________________________________

    Expiration Date _________________________________________________________

    Security Code _________________________________________________________

    Billing Address _________________________________________________________

    City, State, Zip _________________________________________________________

    Phone Number _________________________________________________________

    Date of Birth _________________________________________________________

    Marital Status _________________________________________________________

    Home Address _________________________________________________________

    How long living at current Address ___________________________________________

    Legal Name _________________________________________________________

    Social Security _________________________________________________________

    Amount to be Charged_____________________________________________________
    $49.09 per borrower

    By signing this form, you authorize ________________________________________________________


    Xactus LLC Credit Reporting Agencies
    To charge your card for the amount listed above.

    Signed:________________________________________________Date: __________________

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