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AUTHORIZATION AGREEMENT CREDIT or DEBIT CARD PAYMENT I (we) hereby authorize CHASE COUNTY COMMUNITY HOSPITAL×CLINIC, herein after called CCC, to debit entries to my (our) Credit Card indicated below,
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How to fill out a credit/debit card authorization:

01
Start by gathering all the necessary information. You will need to have your credit/debit card in front of you, along with the authorization form provided by the merchant or organization requesting payment.
02
Fill in your personal details. This typically includes your full name, billing address, and contact information. Make sure to enter this information accurately to avoid any issues with the authorization process.
03
Enter your credit/debit card details. This includes the card number, expiration date, and CVV/CVC code. Again, it is crucial to double-check these details to ensure accuracy.
04
Specify the payment amount. Indicate the exact amount you are authorizing the merchant or organization to charge to your credit/debit card. This could be a specific dollar amount or a range, depending on the terms of the transaction.
05
Sign and date the authorization form. Your signature on the form confirms your consent and agreement to the charges. Additionally, provide the current date to establish the timeframe of the authorization.

Who needs credit/debit card authorization:

Credit/debit card authorizations are typically required by merchants or organizations that offer goods or services and accept card payments. This can include online retailers, hotels, car rental agencies, subscription services, and many other businesses. The authorization serves as a legal agreement between the cardholder and the merchant, granting permission to charge a specified amount to the card. It acts as a safeguard for both parties, ensuring that transactions are authorized and legitimate.
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Credit/debit card authorization is the process of verifying and approving a transaction using a credit or debit card.
Merchants and businesses that accept credit or debit card payments are required to file credit/debit card authorization forms.
To fill out a credit/debit card authorization form, provide the cardholder's name, card number, expiration date, CVV code, and the amount to be authorized.
The purpose of credit/debit card authorization is to ensure that the cardholder has enough funds or credit limit to cover the transaction.
The information reported on a credit/debit card authorization form includes cardholder's name, card number, expiration date, CVV code, and transaction amount.
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CCCH MasterCard origination DEBIT guarantor herein notification Expiration transactions entries MAILING termination HOLDER provisions

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