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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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