One Time Credit Card Payment Authorization Form - Ah Wilkens
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1A.H. Wilkens Auctions & Appraisals
299 Queen Street East, Upper Gallery
Toronto, Ontario
M5A 1S7
P: 416.360.7600
FAX: 416.360.8900
One Time Credit Card Payment Authorization Form
Sign and complete this form to authorize A.H. Wilkens Auctions & Appraisals Inc. to debit a $5,000 deposit from
the credit card listed below in order to register and participate in our June 9
th
/10
th
2015 catalogue auctions. Should
your bid be successful, the amount will be used towards the outstanding balance.
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.
**Please note that if you are unsuccessful in your bid at the auction, the funds will be returned to you within 48 hours
of the auction date.
Please complete the information below:
I ____________________________ authorize A.H. Wilkens Auctions & Appraisals Inc. to charge (as a deposit)
(full name)
my credit card number indicated below for
before the commencement of the June 9
th
auction.
$5,000.00
(amount)
(date)
This payment is for the ability to participate in bidding in our June 9
th
/10
th
catalogue auction.
(description of goods/services)
Billing Address ____________________________
Phone# ________________________
City, State, Zip ____________________________
Email ________________________
Account Type:
Visa
MasterCard
Cardholder Name
_________________________________________________
Credit Card Number
_____________________________________________
Expiration Date
____________
CVV2 (3 digit number on back of Visa/MC) ______
Signature ____________________________
I agree that the information provided is honest and true and that it matches to client information provided through my
online account (liveauctioneers or )
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