Verification Of Employment Credit Card Authorization printable pdf download

Verification Of Employment Credit Card Authorization

320 S. Milliken Ave. Ste A

Ontario, CA 91761

(909) 390‐9404 ◊ (909) 390‐9510 fax

VERIFICATION OF EMPLOYMENT

CREDIT CARD AUTHORIZATION

Requested Date:

Requester Name:

Requester fax number:

Requester Email:

Requester phone number:

Requester Address:

Credit Card Type:

Visa

MasterCard

American Express

Discover

Cardholder’s Billing Address:

Credit Card Number:

Expiration Date:

*CVV Code:

*Discover, MasterCard and Visa – 3 digit CVV code (card verification value) on the back of the card.

American Express – 4 digit CVV code (card verification value) on the front of the card.

Total amount of transaction:

$20.00

Authorized Cardholder Signature: X

(By signing above you agree to be charged $20.00 for one employment verification on the employee listed below)

Name of employee:

***Executed credit card authorization form must be accompanied by an employee signed release***

Receipt Requested:

Yes or

If you answer yes, please let us know if you would like it:

faxed or

emailed

Verification Of Employment Credit Card Authorization