CREDIT CARD AUTHORIZATION FORM

Cardholder Information

Full Name(Required)

Phone(Required)

Email(Required)

Billing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Credit Card Information

Card Type(Required)

Visa

Master Card

American Express

Discover

Name on Card(Required)

Card Number(Required)

Expiration Date (MM/YY)(Required)

CVV (3 or 4 digits)(Required)

Recurring Payment Authorization

Recurring Charges(Required)

Monthly

Quartely

Annually

Authorization

I authorize AvMar Accounting to charge the credit card listed above for the recurring payment frequency selected. I certify that I am the authorized cardholder and that the information provided is accurate. I understand that AvMar Accounting maintains administrative, technical, and physical safeguards to protect my payment information and processes card transactions in accordance with PCI-DSS standards. This authorization will remain in effect until I provide written notice of cancellation with reasonable time for processing.

Signature(Required)

Printer Name(Required)

Date