Credit card authorization form

All information will remain confidential. All your credit card information submitted here will be encrypted in our database.

Name on card: *

Enter the name as it appears on the credit card.

Card number: *

Expiry month: *

Enter the two-digit numeric value of the expiry month.

Expiry year: *

Enter the four-digit numeric value of the expiry year.

Security code (CVV): *

Address: *

Address of the business or billing address

City: *

Postal or ZIP code: *

Your e-mail address: *

Enter your e-mail address, the person submitting this form. This will be used to communicate with you in case any information needs clarification or correction.

Website: *

Enter your name, the person submitting this form. Sometimes this is different from the cardholder's name.

Your name: *

Enter your name, the person submitting this form. Sometimes this is different from the cardholder's name.

Your telephone number: *

Authorization: *

I authorize U7 SOLUTIONS to charge the agreed amount to this credit card. Refer to your original quote or our e-mail communications for pricing. I agree that I will pay for this purchase in accordance with the issuing bank cardholder's agreement.

Leave this field blank:

Credit card authorization form

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Website Design | Website Development | Digital Marketing
Website Maintenance | Business Tools