Charge Card Authorization
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Charge Card Authorization Form. This is a Official Federal Forms form and can be use in Consumer Arbitration American Arbitration Association.
Tags: Charge Card Authorization, Official Federal Forms American Arbitration Association, Consumer Arbitration
CHARGE CARD AUTHORIZATION
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For Central Office Use
Processed by: _______________________________ Date:_________________
Approval Code: ______________________________
Submitted by: ________________________________ Date:_________________
Case No: __________________________________________
Party Name: ________________________________________
Invoice#
Amount
Invoice Date
__________
_________________
______________
__________
_________________
______________
________Visa
_______MasterCard
_______ American Express
Amount Charged: $_________
Account Holder Name: ____________________________________
Card Number: ____________________________________________
Expiration Date: ______________________________
_______________________
Signature
_____________________
Date
Address: ____________________________________________________
City: ____________________________ State: _________ Zip Code: ________
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