Credit Card Verification Form & Agreement
In order to verify your credit card transaction, please complete and submit the following:
- Please provide the required information and print the form.
- Ensure that the agreement is signed and date.
- Take a photo of the signed form using your smart phone, along with copies of the front and back of your card(s).
- Provide a photo of a valid government issued ID.
- Submit the images of the signed form, credit card(s) and photo ID in JPEG or PDF format to firstname.lastname@example.org.
To ensure we process your documents without delays, we kindly ask that the name, address, card details and signature on the form are clear and legible.
IMPORTANT: Please read the following carefully before signing and dating.
By submitting this signed and dated form, along with the additional information requested, I am authorizing and fully acknowledging that:
- I acknowledge that this account was registered using my personal information and all transactions were initiated and authorized personally, using the above credit card.
- I agree that all transactions made in my account will be paid in full.
- I agree that any and all uncollected purchases or delinquent accounts are subject to 3rd party credit reporting and collections.
- I am over 18 years of age.
- I have read and accepted the terms described in the Transaction Processing Agreement.