Credit card authorization form template

Most merchants have printable authorization forms that don’t comply with the basic requirements to protect against disputes or don’t comply with Payment Card Industry Data Security Standards (PCI Compliance) guidelines.
Download this Credit card authorization form template and modify as you wish.


This form contains language suitable for businesses where all of these elements apply:

  • business to business
  • card not present – phone, fax, email, or other order (not ecommerce)
  • repeat customers with sales of variable amounts; need to bill customers on an occasional or regular basis for varying purchases
  • sensitive card data is stored via a PCI compliant solution that replaces card data with a ‘token’ ; the token is linked used to charge the card

Card Acceptance Guidelines for Visa Merchants

You won’t find a “fax authorization form” in the guidelines, however, there is much information about receipt requirements.

Do you want to empower your customers to pay 24/7 via a secure pay online page? Would you like to reduce scope for PCI Compliance?

Would you to eliminate fax authorization forms that expose card data?   Contact Christine Speedy at 954-942-0483.

3 thoughts on “Credit card authorization form template

    • The site has many forms so I can’t respond specifically for your situation. Here’s my comments for the “basic” form:

      – The form authorizes one time and/ or recurring sales and it contains CVV. CVV can’t be stored per card acceptance guidelines and Payment Card Industry Data Security Standards (PCI DSS) . If you shred the form to comply with PCI, what protection do you have from losing disputes (120 days)?

      – Form does not contain standard cardholder agreement language

      What’s the cost of non-PCI Compliance? A merchant has to get caught first. In the event of a breach, 80% of companies go out of business in one year due to related financial losses. Card brands can disallow a company to accept credit cards. Non-PCI compliance is not a viable option to run a business.

      What’s your risk of lost disputes?
      It’s hard to say, but it doesn’t seem to be an issue for you anyway. Additional supporting documentation might help overcome issues with the form, and it might not.

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