Credit Card Authorization Form

Credit Card Authorization

I/We hereby authorize SecureSearch Background Checks to utilize and charge the credit card provided below for all activity billable to our account, including monthly invoices and any per-search fees incurred. This card will remain on file as the default payment method until a change is submitted via this form. Any debit/credit card updates must be submitted through this form only.

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:

By completing this form, you authorize SecureSearch Background Checks to charge the credit card provided above for all activity billable to your account, including monthly invoices and per-search fees. This authorization remains in effect until a written change is submitted via this form. Any fraudulent use of this form is the sole responsibility of the submitting party.

Authorized By:*

Your Title/Position*

Authorization Statement*

I am an authorized representative of the organization named above. I hereby authorize SecureSearch to update the credit card on file and charge it for all monthly invoices and per-search fees until a new authorization is submitted.

Authorized Digital Signature*

Contact Email*

Phone*

Is the Contact above a New Invoice/ACCOUNTS PAYABLE Contact?*

Yes
No

Is this card to be used Organization-Wide?*

Yes
No

Today's Date*

UPDATE CC INFO