![]() Enter the name of the merchant (can be the name of a company or of a person).Enter the full name of the customer (the person authorizing the charge).For example, if the customer canceled their subscription, the merchant should keep their authorization form on file for at least ninety (90) days after their last payment.ĭownload: PDF, Word (.docx), OpenDocument Step 1 – Customer + Merchant InfoĪt the top of the form, the following information will need to be provided: The form should be stored for at least three (3) months after the customer has been charged for the last time. If a charge is made in a greater or lesser amount than is specified on the document, the merchant will not be protected from the customer initiating a chargeback. It is very important that the merchant charges the same amount ($) as was entered onto the form. With the completed authorization in hand, the merchant can begin charging the customer’s credit card or withdrawing from their bank account. Step 3 – Charge Card / Withdraw from Bank Their signature can be collected by uploading the authorization form to eSign or by printing the document and writing it by hand. Once all other fields have been completed, the customer will need to input their payment method (credit card or bank info) followed by their signature. Information such as the contact info of the merchant, the amount ($) of the charge, whether it is recurring or not, and the date of recurring payment (if applicable) can be filled in to make the template. Then, the merchant will only need to make a copy of the template for each future customer. If the merchant will be using an authorization form for the same type of charge for multiple customers on a regular basis, they may choose to complete specific fields ahead of time so that they have a template they can keep reusing. Once the customer opts to sign up for a membership or subscription with the merchant, they should be given the authorization form to complete. The date (mm/dd/yyyy) the customer signed the authorization form.The signature of the customer (by hand or digitally via eSign).The name of the person on the account (customer name).The account type (savings or checking).The type of card (VISA, AMEX, Mastercard, etc.).Whether payment will be made via credit card or bank (ACH).Phone number and email (optional, but recommended).The date of each recurring payment (if applicable).Whether the charge is one-time or recurring.To sufficiently protect the issuing company from a chargeback, the form should contain the following information (at a minimum): Transaction Info Step 3 – Charge Card / Withdraw from Bank. ![]() Recurring ACH (Bank) Payment Authorization.1-Time ACH (Bank) Payment Authorization. ![]()
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