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Download the recurring payment credit card authorization form (for credit cards or bank accounts) in Adobe PDF, rich text format (.rtf), and Microsoft Word (.doc) to allow an individual or a company to charge a credit card or bank account on a timely basis. The most common frequency is once per month, but can be authorized by day or week. After the form has been filled-in it must be held by the person or entity charging the payment.

How to Fill-in

Download the form and begin filling in the details as follows:

Part 1 – Enter the company name including its street address and phone number.

recurring-payment-authorization-form-part-1

 

Part 2 – Enter the recurring payment information including the payee, business name authorized, amount authorized, date of payment, frequency, type of bill, billing address, phone number, and email.

recurring-payment-authorization-form-part-2

 

Part 3 – Enter the checking account/savings account or credit card information.

recurring-payment-authorization-form-part-3

 

Part 4 – Signature, Date, the Business Name, and the NSF fee.

recurring-payment-authorization-form-part-4

Preview

Adobe PDF

MS Word

Rich Text