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This document is a credit card payment authorization form allowing clients of the Midwest Center for Psychotherapy & Sex Therapy to authorize billing for their session fees directly to their credit

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What is credit card payment authorization?

Credit card payment authorization is the process by which a credit card holder gives permission to a merchant or service provider to charge their credit card for a specific amount in exchange for goods or services.

Who is required to file credit card payment authorization?

The person or entity accepting credit card payments is required to file credit card payment authorization. This includes merchants, businesses, and service providers.

How to fill out credit card payment authorization?

To fill out credit card payment authorization, the credit card holder must provide their name, credit card number, expiration date, billing address, and the amount they authorize to be charged. A signature may also be required.

What is the purpose of credit card payment authorization?

The purpose of credit card payment authorization is to ensure that the credit card holder has given consent for the transaction and to protect both the merchant and the cardholder from unauthorized charges or fraudulent activity.

What information must be reported on credit card payment authorization?

The credit card payment authorization must include the credit card holder's name, credit card number, expiration date, billing address, the authorized amount to be charged, and the merchant or service provider's name and contact information.

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