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1 similar Credit Card Authorization Form contracts
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Form • July 11th, 2018
Organization Information Name: Address: Postal Code: Fax: ( ) Telephone: Bus. ( ) Res. ( ) E-mail Address: Preauthorized Credit Card Payment Card Holder's Name: Credit Card Number: ~ ~ ~ Expiry: / Type of Credit: Visa / MasterCard / Debit Agreement I understand and agree that I am authorizing the Simcoe County District School Board (SCDSB) to debit the appropriate amount from the above credit card account to cover the cost of the transcript(s) issued to the above-mentioned person. Payment for the full amount of the Transcript/s $ Signature of Authorized Cardholder Date Authorization If cardholder is different than applicant, the applicant must sign below to authorize method of payment Name Signature Date
