Credit Card Authorization Form Template

If you run/operate a cleaning company selling on the phone is a must!! Below are individual scripts based on type of service. These sales scripts also include pricing which can be customized based on your own pricing. If you do need assistance with customizations, I'd be happy to assist. You may contact me here.

Credit card Authorization Form

In order for BA HOUSE CLEANING LLC to accept and bill your credit card, please complete all fields below,sign, date and click on submit.

All information sent is strictly confidential and BA HOUSE CLEANING LLC adheres to the highest standards of account data protection.

Billing Information: (as it appears on your credit card statement)

Company:

Customer name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Confirmation EmailEmail must match to current email on file

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Amount

USDCleaning cost + 3% convenience fee

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Please Check the Appropriate Box(es):

One Time Use: I hereby authorize BA HOUSE CLEANING LLC to charge the indicated credit card the amount indicated above. This is a one-time charge authorization. I am not authorizing BA HOUSECLEANING LLC to setup my account within a recurring billing system. I understand that if I want BA HOUSE CLEANING LLC to charge any balances to my credit card in the future, I will need to submit another authorization form at that time or choose the selection below.

Signature

Date