[your logo here]

Credit Card
Authorization Form
[your business name here] Professional SEO
Prepared by [your name here]

[your business name here]

1. AUTHORISATION

This authority provides the staff of [your business name here] with the approval to use the credit card
account shown below for services or payments required in order to complete the set tasks as outlined
within the SEO proposal. These services cover aspects such as content development, paid directory
submissions, and web press releases. The client will be notified before commencement of any
transactions to ensure confirmation.

2. BUSINESS INFORMATION

First Name _________________________________________

Last Name _________________________________________
Company Name _________________________________________
Email Address _________________________________________
Address 1 _________________________________________
Address 2 _________________________________________
City _________________________________________
State/Region _________________________________________
Postcode _________________________________________
Phone Number _________________________________________
ABN _________________________________________
Mobile _________________________________________

3. CREDIT CARD DETAILS

Card Type Bankcard MasterCard Visa

Card Number
Card Expiry Date
Name of Cardholder
(as it appears on the card)
Cardholders Signature
_________________________________________
___________________________ CVS # ________
_________________________________________
_________________________________________

I/We hereby give permission to the staff of [your business name here] to use the account listed above in
order to perform transactions where necessary.
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[your business name] Credit Card Auuthorization Form

Signed by _________________________________________ Date _____________

4. Fax Mailing Instructions

Print and Fax this form to:

[your business name here] – Professional SEO – Fax [your fax number here]
Or print and mail this form to:
[your business name here] – Professional SEO
[your address here]

5. General Enquiries

Enquiries or Questions may be directed to

[your business name here] – Professional SEO
Name [your name here]
Email [your email address here]
Office [your office number here]
Mobile [your mobile phone number here]
Address [your postal address here]

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