Free credit card authorization form

A signed form that lets you charge a customer's card for a set amount or for each visit. It is built so the full card number is written by hand on paper, never typed into this page.

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Your business
Logo
Kept in this browser for your next document. It is not uploaded.
Optional. Add it if your trade is licensed where you work.
Cardholder
Credit card authorization details
Never type the full card number here. The printed form has a line for it, filled in by hand.
$
Wording
Section 1
Section 2
Section 3
Section 4
sections on this credit card authorization
4
Credit card authorization
Run this in Koira for freeKept in this browser only. Nothing you type here goes to Koira. The CSV opens in Google Sheets and Excel. In the print window, pick Save as PDF.
Your business name

Credit card authorization

CardholderCardholder name
Card type
Visa
How it will be charged
One payment
Authorization
I authorize the business named above to charge the card below for the amount and in the way stated on this form. I confirm I am the cardholder or am authorized to use this card.
Card details, written by hand
Name on card: ______________________________ Card number: ______________________________ Expiration: ________ Billing ZIP: ________ This form does not ask for the card's security code.
Changes and cancellation
I can cancel this authorization in writing at any time for charges not yet made. A receipt will be sent for each charge. Disputed charges should be raised with the business first.
How we keep this form
This form is kept on paper in a locked place, or destroyed once the last charge is made. The card number is never emailed or texted.
Cardholder signature
Date

When you need one

Use a card authorization form when you will charge a card without the customer there to tap or type it: a balance due when the job is done, a recurring service charged after each visit, or a no-show fee your policy allows. The signed form is your proof the customer agreed if they later dispute the charge with their bank.

Keeping card numbers safe

  • Never type a full card number into an email, a text, a shared spreadsheet or this page.
  • Write it on the printed form, keep the form locked away, and shred it when the last charge is done.
  • Do not keep the card's security code.
  • Your card processor's own rules and the card networks' security standards apply to you; read your processor's agreement.
A better way to keep a card on fileA payment link saves the card with the processor instead of on paper. In Koira, the customer pays from a link or at the door, and you never see or store the number.

What to put on the form

  • Your business name and contact details.
  • The cardholder's name, billing address and phone.
  • The card type and last four digits, so you can match it without the full number.
  • The amount, or the most you may charge, and when.
  • What the charge is for: the job, invoice or service plan.
  • The cardholder's signature and date.

More free templates

FAQ

Is a credit card authorization form legally required?

Generally not, but it is your best evidence that the customer agreed to a charge made without them present. Card processors often ask for it when a customer disputes a charge.

Can I store a customer's card number on paper?

Many small businesses do, but it carries risk. Keep the form locked, limit who can see it and destroy it when you no longer need it. Saving the card with your payment processor avoids holding the number at all.

Does a signed form stop chargebacks?

No form stops a customer from disputing a charge with their bank. A signed authorization, a clear receipt and proof the work was done give you a strong answer when you respond to the dispute.

Can I use one form for recurring charges?

Yes, if the form says the charges recur, how often, and the amount or the most each charge can be. Send a receipt each time, and stop charging when the customer cancels in writing.

We know what works. Leave it to Koira.

☼⚙
Standard⚡ Turbo
● Koira did it● You by hand
Today $9,300$8,100 / $1,200
This week $25,050$18,570 / $6,480
This month $69,300$46,150 / $23,150
Money, just now
Reminded Sean Love, $1,850. Polite reminder with the pay link.
Bids, 9:44 am
Nudged Dana on the kitchen bid. Day 3 follow up. She opened it at 9:12.
Convos, 9:41 am
Texted back a missed call. Walk through booked Thu 10:00.
Free Credit Card Authorization Form Template for Contractors | Koira