Credit Card Authorization Form

UPDATE CC INFO

Credit Card Authorization
I/We hereby authorize SecureSearch Background Checks to utilize and charge said credit card for all activity billable for SecureSearch Background Checks. Any debit/credit card changes need to be submitted to SecureSearch Background Checks via this form. *Please Note: starting 09/01/2025 a 2.9% fee will be added
Customer/Business Name*
PAYMENT METHOD
Name on Card*
Credit Card Type*
Credit Card Number*
Expiration Month*
Expiration Year*
Credit Card Security Code*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
AUTHORIZED BY:
Authorized Digital Signature*
Contact Email*
Phone*
Is this person the new invoicing Contact?*
- Yes
- No
Is this change for credit card Holder only?*
- Yes
- No
Today's Date*
MM slash DD slash YYYY