Credit Card Authorization Form

Credit Card Authorization

Date______________

Company Name___________________________________

Name As It Appears on the Card__________________________________

Cardholder's Billing Address__________________________________________________
Address
___________________________________________________
City, State and ZIP CODE

Contact Phone Number For Cardholder ____________________________

Visa/MC/Amex#_________________________________Expiration Date___________

CVV# (for VISA & M/C back of card________ CID# ( for AMEX front of card)____________

**I authorize SilverForte to charge my Visa/MC/Amex for all further purchases of merchandise shipped. 
I understand that this is your written authorization to charge these shipments to my charge cards indicated above. This agreement is valid until written notice of cancellation is received.

Cardholder's Signature X__________________________

If cardholder's billing address is outside of the US, please also provide 1) a photocopy of the front and back of the credit card, 2) a photocopy of the cardholder's passport or identification card, AND 3) the information below for the card-issuing bank. Thank you!

Name of Bank: _____________________________ Telephone No. ____________________

Address of Bank: _________________________________________________________________

To cancel the above Charge Card Authorization, please provide the information below.
This is my authorization to CANCEL the above agreement:

Company Name: _______________________

Credit Card Holder: ____________________

Date Of Cancellation: ___________________