Credit Card Authorization

Sign and complete this form to authorize Ice Cream Occasions’ to make a one-time charge to the card listed below. By signing this form, you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.

Full Name*
Invoice Number*
Amount*
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Today's Date*
Month
Day
Year
Account Type*
Card Holder Name*
Credit Card Number*
Expiration Date*
CVV/Security Code*
Billing Address*
Street Address Address Line 2 City State ZIP Code
Email*
Signature*
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Credit Card Authorization

1-800-900-7917

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Date Needed

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