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CREDIT CARD AUTHORIZATION (TO BE FILLED OUT BY THE PATIENT/cardholder) Completing this form authorizes Mealtime Laboratories, Inc.(RTL) to charge the following credit card for services and/or purchases

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How to fill out authorization to bill credit

01

Fill out the name and address of the billing entity

02

Include the customer's information such as name, address, and account number

03

Specify the amount to be charged and the frequency of the billing

04

Include the credit card information such as the card number, expiration date, and security code

05

Sign and date the authorization form

Who needs authorization to bill credit?

01

Any business or individual who wishes to bill a customer's credit card on a recurring basis

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What is authorization to bill credit?

Authorization to bill credit is a signed agreement allowing a company to charge a customer's credit card for services or products.

Who is required to file authorization to bill credit?

Any company or individual who wishes to charge a customer's credit card must file authorization to bill credit.

How to fill out authorization to bill credit?

Authorization to bill credit can be filled out by including the customer's name, credit card information, amount to be charged, and a signature.

What is the purpose of authorization to bill credit?

The purpose of authorization to bill credit is to legally allow a company to charge a customer's credit card for agreed upon services or products.

What information must be reported on authorization to bill credit?

Information such as customer name, credit card number, amount to be charged, and signature must be reported on authorization to bill credit.

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