Credit Card Authorization Form

Credit Card Authorization Form - Scott's Used Parts

Order Number/Item Description

Ordered From

Type of Card Being Used

Credit Card Number

Expiration Date

CVC

Upload Photo of ID (Driver's License, State ID, Passport)

Credit Card Billing Information

Cardholders First and Last Name

Billing Address

City

State

Zip Code

Phone Number

Shipping Information

First and Last Name

Shipping Address

Shipping City

Shipping State

Shipping Zip

Shipping Phone Contact Number

Credit Card Holder Signature

Enter Date

Accept Terms & Conditions

As the credit card holder, I hereby authorize Scott's Auto Inc. to charge my credit card in the amount of purchase (including shipping and/or taxes, if applicable). As the credit card holder, I hereby authorize receipt of merchandise at the shipping address above, and agree to vendor's in store policies. Your completion of this authorization form helps us to protect you, our valued customers, from credit card fraud. All information entered on this form will be kept strictly confidential by our company.