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Credit Card PreAuthorization Form
Client Name: ___ Client DOB: ___The undersigned Client/Cardholder hereby authorizes Creekside Counseling +Wellness, through TherapyNotes and Reconnect, to obtain payment for fees for services, co-payments, late cancel* or missed
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How to fill out credit card pre-authorization form

How to fill out credit card pre-authorization form
01
Obtain a credit card pre-authorization form from the merchant or business.
02
Fill out your name, address, contact information, and credit card details on the form.
03
Specify the amount you are authorizing the merchant to charge to your credit card.
04
Sign and date the form to acknowledge your authorization.
05
Submit the completed form to the merchant or business for processing.
Who needs credit card pre-authorization form?
01
Any individual or organization making a booking or reservation that requires a deposit or guarantee may need to fill out a credit card pre-authorization form.
02
Businesses that offer services or accommodations that have a cancellation policy or potential for incidental charges may also require customers to fill out a credit card pre-authorization form.
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What is credit card pre-authorization form?
A credit card pre-authorization form is a document used to obtain approval from a credit card issuer before accepting a transaction. It verifies that the cardholder has sufficient credit available for the transaction amount.
Who is required to file credit card pre-authorization form?
Businesses that process credit card transactions may be required to file a credit card pre-authorization form to ensure they have the necessary approval before completing a sale.
How to fill out credit card pre-authorization form?
To fill out a credit card pre-authorization form, include the cardholder's name, credit card number, expiration date, amount to be authorized, and the merchant's information. Ensure all details are accurate to avoid transaction issues.
What is the purpose of credit card pre-authorization form?
The purpose of a credit card pre-authorization form is to protect merchants from fraud and ensure that funds are available before processing a transaction, mitigating the risk of chargebacks.
What information must be reported on credit card pre-authorization form?
The information that must be reported includes the cardholder's name, credit card number, expiration date, billing address, amount of the transaction, and the purpose for pre-authorization.
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