The Art of Fine Wood Sculpting

One (1) Time Credit Card Payment Authorization  (please print or or copy in landscape form)

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Sign and complete the form to authorize                                                       (sellers name) to make a one time 

charge to your credit card listed below.

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By signing this form,you give us permission to debit your account for the amount indicated on or after the indicated date.

This is permission is for a single transaction only, and does not provide authorization for any additional unrelated debits 

or credits to your account.

I                                                         (buyers name)    authorize                                                      (sellers name) to charge my credit 

 

card account indicated  below for the  $                                                           ( amount plus sales tax)  on                                                                                                                                               (

 

(date)

 

The payment is for                                                                                                           (description of goods/service).

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Billing Information    

 

Billing Address                                                                 .Phone #          

 

City,State,Zip                                                                 . Email                 

 

 

 

(Visa, Mastercard,Discover,American express)  circle card type.

 

 

Cardholders name:

 

Credit Card Number :

 

Expiration Date :

 

CV V  :                                             ( 3 numbers usually at the back of card)

 

Zip Code: 

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I authorize the above named person /business to charge the credit card indicated in this authorization form 

according to the terms outlined above.This payment authorization is for the goods/services described above,

for the amount indicated above only, and is valid for one time use only.I certify that I am the authorize user

 of this card and will not  dispute the payment with my company so long as the transaction corresponds to the

terms indicated on this form

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SIGNATURE                                                               (cardholder).                 DATE                                                      

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