La quinta credit card authorization form. With the Wyndham Rewards Earner ® Cards, you can earn up to 45,000 bonus points—enough for up to 6 free nights at thousands of properties worldwide. La quinta credit card authorization form

 
With the Wyndham Rewards Earner ® Cards, you can earn up to 45,000 bonus points—enough for up to 6 free nights at thousands of properties worldwideLa quinta credit card authorization form  Draw your signature, type it, upload its image, or use your mobile device as a signature pad

Type text, add images, blackout confidential details, add comments, highlights and more. This permission is typically given verbally or in writing. Place your Form G-1450 ON TOP of your application, petition, or request package. Sign it in a few clicks. With more hotels than anyone else, we offer the largest and widest collection of hotel experiences in the world. **Submit this form together with a photocopy of cardholder's credit card, front and back, make sure to mask out the CVV. Edit la quinta credit card authorization form. For recurring transactions, the time limit may be as short as one day. co m Credit Card All reservations that are guaranteed with a credit card are held for late arrivals. Use Canary PCI Level-1 Compliant hotel technology for secure contactless check-in and process credit cards, contracts, and amenities online. Inviting hotel with meeting space off US-50 near downtown. The Radisson Hotel credit card authorization form is used to allow a third (3rd) party to charge the cardholder’s credit card or debit account in order to pay for a hotel room. La quinta credit card authorization form. Gift Certificates. Thank you, Michael West General Manager La Quinta Inn & Suites #186 Austin Airport LQ Management, L. . Request for Public Records - Traffic Camera Footage. Step 1 – Download the document – Submit: The name of the authorized individual. Usually, in these types of transactions, the credit card holder is making a reservation for another entity. Sign, fax or pushable from PC, your, black or mobile with pdfFiller Instantly. CREDIT CARD AUTHORIZATION FORMS All guests must provide a physical credit card in order to check-in. It's a credit card authorization form that is asking me to fill in my credit card information and fax it. Printing both scanning is no length the best way the manage documents. 538. Obtain to up-to-date la quinta financial card authorization form 2023 immediate Get Form. Click Add an employee on the right side of the page. It also has a $0. orgHow to Write. You can view, add or edit these consent documents at Settings > Client Portal > Shared Documents and Files. The Night Auditor reviews the VIP column on the Arrival Grid and identifies all La Quinta Returns No-Show reservations. Inviting hotel with meeting space off US-50 near downtown. Attract new business and capture new clients. At La Quinta ® by Wyndham Dodge City, you'll have everything you need for a pleasant stay just minutes from the downtown area. Wyndham credit card authorization form. Merchants whose business is hospitality, vehicle or equipment rental, or related services may be allowed as many as. T: 800-225-1620 F: 304-387-1643 > Contact UsUpdated September 18, 2023. First name*. To individual or group wishing to pay for their stay by a La Quinta Inns & Suites location with a credit chart other than their own will have to query a completed La Quinta hotel. Attach this form to your document, certificate or other written request. Sign-up Bonus. Credit Card Type Card Number Expiration Month (MM) Expiration Year (YYYY) CVV/Security Code. sirusa. No. It also protects the cardholder by only authorizing certain charges within a specified time frame, so the traveler can’t use the card on unapproved expenditures. To pay for a room, a third-party individual must fill out the Hyatt Credit Card Authorization Form, sign and fax it to the hotel, or contact the property directly to arrange payment if the relevant property. It’s essential that the “Charge Amount” is correct. Step 3 – Next, include the guest name, the confirmation number and the arrival date. To create an employee: Go to Employees on the left navigation panel. It has a relatively low rate of 13. Step 2 – Once the document is open in your PDF viewer of choice, enter in the name of the company whose credit card is being charged, their address, and the company phone number. It is actually your. Completing La Quinta Credit Card Authorization Form 2020-2023 online with US Legal Forms. Create simple or complex workflows, and route submitted data to your third party apps for easy storage. Get Form. A 10% points discount on redemptions for free nights, and no foreign transaction fees. Save or instantly send your ready documents. Associate Discount Policy | Discount Voucher **. * Hotel reserves the right to refuse a credit card authorization as a valid method of payment for same day bookings or authorizationCredit Card Authorization. 46. The full service hotel I was at, the managers were pushovers to the max. I am suspicious of this and want to know if this is standard when booking with airfare. Sign, fax and printable from PC, iPad, tablet or mobile with pdfFiller Instantly. Choose My Signature. 5. It also obtains card holder’s signature. On any device & OS. Card authorization is required for both online and in-person transactions. How to fill out credit card authorization form: 01. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. In order to pay for a Reservation on behalf of another Guest, you must contact the Hotel directly and ask to speak with the Front Desk. Start completing the fillable fields and carefully type in required information. 7625 E. You should now be able to fill in the form directly, either by typing in the fields or by handwriting. That’s why the cardholder has filled in the details needed to verify the funds. We used cookies to improve data, personalize the user experience, upgrade our marketing related (including cooperating with our business partners) and for. Such form is typically used by businesses so they can charge a cardholder on an ongoing basis. A receipt for each payment will be provided to you and the charge will appear on your credit card statement. pa164 choicehotels. 02. 02. To protect your credit card information, do not submit this form electronically . There are three variants; a typed, drawn or uploaded signature. The customer presents a card for payment at the point of sale. Draw your signature, type it, upload its image, or use your mobile. The one I currently work at requires you to send a copy of the front of the card and the ID of the person who owns that card as well (since we live in shady town and get a lot of obviously fraud forms). Use Formstack Sign or an electronic signature solution you already use to easily have this template signed. Log in to the editor with your. We’re a passionate group of hoteliers, technologists, and customer success professionals building the future of hospitality. Check out signNow online tools for document management. View La-Quinta-Hotel-Credit-Card-Authorization-Form. Reduce chargebacks and fraud by up to 90% Canary's Digital Authorizations solution reduces fraud & chargebacks by up to 90%, and helps hoteliers win them when they occur. SXSW Housing & Travel sends hotel reservations to our hotels in mid to late February. Name on Card: * The credit card listed below may be billed for the estimated charges Ten (10) days prior to event/reservation date. Hotels That. **Without the copy’s of. However, how a hotel does so can have large effects on guest data security, PCI corporate, staff efficiency, the invitee experience and find. Create your signature and click Ok. Decide on what kind of signature to create. com credit card authorization telephone orders/additional signator date i, , hereby authorize studio instrument rentals to utilize the below. Provide the date in which the authorized individual will have permission to make the transaction in mm/dd/yyyy format. San Fernando, CA 91340. GROUP-CREDIT CARD AUTHORIZATION FORM ATTN: CARMEN ROMERO FAX TO: (210) 228-9816. Our modern hotel provides you. La Quinta Inn Credit Card Authorization Form someone: fill, sign, print and send online instantly. For the majority of card-not-present merchants in an eCommerce environment, the maximum length of a card authorization hold is seven days. L. Last name*. Keep your guests’ credit card information secure. Office of International Programs. doc Author: Jim Maxwell Created Date: 11/22/2011 7:06:15 PM01. This article is part of a larger series on . Get la quinta inn credit card authorization form signed from your mobile device using these 6 tips: Make any changes needed: add text and photos to your La quinta credit card authorization form, highlight information that matters, erase sections of content and replace them with new ones, and add symbols, checkmarks, and areas for filling out. Fill-out the BPI Card Authorization form and provide a copy of your ID along with the ID of your representative. If your late arrival is for the next day, please contact the hotel directly. Name and signature of the cardholder. It’s perfect for collecting card information when making restaurant, hotel. You can book a hotel room without a credit card by using a debit card in most cases. S. Page 1 of 7 Authorization/Extension Valid Through Authorization/Extension Valid From For USCIS Use Only Application For Employment Authorization Department of Homeland Security U. So it is important for you to learn the significance of credit authorization, including the credit card charge authorization form, for secure payment, ensuring smooth transactions. DocHub Reviews. Learn MoreA credit card authorization form is a document giving a merchant permission to process a payment from your credit card without you being physically present and usually at a later date. " | Check out answers, plus 1,176 reviews and 142 candid photos Ranked #7 of 12 hotels in Lake Mary and rated 4 of 5 at Tripadvisor. Let 360 Legal Forms help with our extensive library of attorney-vetted legal forms. How to Write. 03. In addition, debit cards are not to be used for additional charging. 538. com, as I have never booked with them before. Criminal Records Credit Card Authorization Form . It is also worth noting that even though all these hotel chains allow you to book a hotel room for someone else with your credit card, certain locations may still not allow it. 5 of 5 at Tripadvisor. If you won't be traveling with the card you intend to use to pay for the reservation, you'll need to submit a credit card authorization form to the hotel. Leichte on Setup. Edit, sign, and equity la quinta credit card authorization application online. Start by providing your personal information such as your full name, address, contact number, and email address. docx) to begin. 01. To the extent permitted by applicable law, by using the City of La Quinta’s website, the user agrees to defend, indemnify, and hold harmless, the City of La Quinta, its agencies, officers, employees, representatives, and agents from and against all claims and expenses, including attorneys' fees, arising out of the user's use. Report inappropriate content . If using a Debit Card, please be advised that this charge will effect the associated checking account immediately. If you prefer to not use your credit card online, we invite you to contact Best Western reservations by phone at 1-800-564-2515 (North America) or by contacting your regional worldwide reservations center. 627. 15,005. Send la quinta inn credit chart sanction form via email, link, or fax. At the hotel each room comes with a private bathroom. Indicate the date of your stay at the sleep inn and the duration of your reservation. Choose My Signature. The Credit Card Authorization Form is a formal document signed by a cardholder to approve a charge to their credit card for one-time or recurring payments during a specified period. Create a custom l quinta credit card eligibility mold 0 ensure matches your industry’s specifications. Upon arrival, I was sent over a credit card. It can either be a one-time transaction or a charge that. Keep your guests’ credit card information secure. The final charge will. REVIEW RATES; 805-597-6030; 805-439-6985 [email protected] Inn at the Pier. Mode Change to Reinstatement Policy Owner T h et Ca rdol Policy No. Fill in the credit card information section with the appropriate details. A credit card authorization form is a document, signed by a cardholder, that grants a merchant permission to charge their credit card for recurring payments during a period of time as written in that document. Let La Quinta Inn & Suites on Wyndham San Antonio Riverwalk be the bright spots in your travel journey with free breakfast, WiFi, and contemporary guest rooms. Do whatever you want with a La Quinta Inn Credit Card Authorization Form. The post includes a tutorial video and a link to download free credit card on file templates which are. SFA Makerspace. Quick steps to complete and design Wyndham hotel credit card authorization online: Use Get Form or simply click on the template preview to open it in the editor. a bank, credit union, etc. This is a common procedure when an individual authorizes a subscription that renews monthly, such as a gym membership,. Credit Card Authorization Form. *If you choose to allow your credit card to be used for these additional services, the amount authorized will reflect a minimum of an additional 50% of the total amount stay. Next, check off the charges you consent to. A credit card authorization form is a document that grants a business the authority to charge a customer's credit card without the buyer being physically present. Our unmatched collection of iconic hotel brands delivers the experiences everyday travelers want however they choose to travel. Look through the instructions until discover which information your will need in include. Expiration date. Certain individual or group request to pay for own stay at a La Quinta Inns & Suites location because a credit card other faster their own will have to request a completed La Quinta hotel credit card authorization form first. 02. The property is non-smoking throughout and is located 15 miles from Space Needle. This may include your billing address, name, card network, card number, expiration date, CVV, and zip code. Create a custom la quinta credit card authorization form 0 that meets your industry’s specifications. For the credit card authorization process, the document requires the cardholder’s written or e-signature. No need to install software, just los to DocHub, and sign up directly and for free. CREDIT CARD AUTHORIZATION FORMS All guests must provide a physical credit card in order to check-in. A Wyndham Hotels credit card authorization form is a standard Third Party Authorization Form used to verify Reservations made at Wyndham Hotels. 2 - Create a credit card authorization form from scratch. Updated May 31, 2022. Rooms-RoomsRoomsMin length concerning stay needed . Stick go these simple instructions to get In Quinta Borrow Card Authorization Form completely ready for ship: Seek the form you need in our collection a legal forms. Austin North La Quinta Inn features an on-site fitness center and an outdoor. Payment Card Authorization Form. Student Success Center. Complete La Quinta Credit Card Authorization Form 2020-2023 online with US Legal Forms. Most hotel operators don’t even realize that paper credit card forms violate PCI requirements, which are mandated by the credit card companies to keep customer information secure. NOTE: Failure to provide the requested information may result in. Credit card authorization forms typically include the following information: Personal information: This could be information such as the name on the. Two credit or gift cards (split payment) Complete two Form G-1450s, one for each card, and specify the amount you wish to pay with each card. (1) Wyndham Rewards Earner Card with No Annual Fee/Wyndham Rewards Earner Plus Card with $75 Annual Fee - Offer subject to credit approval. Download a credit card and ACH authorization forms which allows a third (3rd) party in the name of a business or individual to charge another person's credit card or bank account. Follow the step-by-step instructions below to design your electronic credit card authorization form: Select the document you want to sign and click Upload. The Hyatt hotels credit card authorization form is a document used to indicate that a guest staying at any one of Hyatt’s 600+ locations can charge a credit card which does not bear their name. Start. Enter the amount authorized to be charged to the credit card amount. Quick steps to complete and e-sign La Quinta Credit Card Authorization Form online: Use Get Form or simply click on the template preview to open it in the editor. Please complete this form in its entirety, include all requested documentation, and fax it to the hotel at least 3 days prior to check-in to allow for processing. In one sense, the term “card authorization” can refer to the authorization itself, as in. HCSB Headquarters 351 Carolina Avenue Chester, WV 26034. Download your finished form and share it as you. Easily fill from PDF blank, cut, additionally sign them. The credit card will only be billed for the exact amount of the items indicated above. Annual fee: $0. 44 reviews. Please take a moment to complete the form below and return it to us. la quinta credit card authorization form Travel Policies and Procedures 19 Jul 2022 — A Travel Authorization ("TA") form must be completed for all UNC travel, regardless of. Learn more. hereby authorize La Quinta Convention Center to bill. The process is fast and easy. Go digital and protect time with signNow, the best get for electronic autograph. 01. Title: 5-Credit-Card-Authorization Created Date:Can I use another party's authorized credit card to pay for my room? Yes. Decide on what kind of signature to create. Join us for a welcoming stay at La Quinta ® by Wyndham Hesperia Victorville, just off I-15 near Edwards Air Force Base. choice hotels credit card authorization form Comfort Inn & Suites 1905 John Fries Highway Quaker town, PA 18951 pH: 215. The cardholder may limit what the guest can charge on the card, such as mini-bar, food, or any extras that the hotel may offer. In some cases, a hotel will accept a third-party credit card if an authorization form is completed and on file before check-in. Canary is headquartered in San Francisco, the center of tech innovation, and New York City, the business and leisure capital of the world. Sign-up Bonus. Step 2 – The number you are faxing the form to, and the individual responsible for receiving the document should be submitted at the top of the page. 2. L. Credit Card Holder's Signature. Headquartered in Irving, Texas, La Quinta Inn & Suites operates over 910 hotel properties with nearly 90,000 rooms in the United States, Canada, Mexico, and Honduras. The Hilton credit card authorization form can be used to make a reservation for a guest. I am traveling with a child. 2. Then the merchant can charge a fixed amount on the card for a specific amount of time. It is actually your. For help accessing your Wyndham Rewards® account, call Member Services at 844-405-4141. Book our Perlmut, MS hotel for an unforgettably stay. The same credit or debit card used to complete an online Pay Now reservation must be presented at the rental pick-up counter as a form of identification. We're also a short drive from the Santa Fe Trail Tracks and Cattle Feedlot. Credit Card Number. Specify how long the authorization is valid for. Sign it in a few clicks. A modern hotel with easy access to Plano, Frisco, and Downtown Dallas. How to authorize a representative to receive your credit card. The La Quinta Credit Card is a great choice for travelers that are always-on-the-go. Please also attach a copy of the front of the credit card. Please check the appropriate box. 627. Most hotel operators don’t even realize that paper credit card forms violate PCI requirements, which are mandated by the credit card companies to keep customer information secure. If you know in advance that you will be arriving late, please make a note of this in the "Special requests" section of the reservation form. 00 plus 3% of the total transaction for allName on Card: * The credit card listed below may be billed for the estimated charges Ten (10) days prior to event/reservation date. Finish redacting the form. 02. Do whatever you want with a La Quinta Credit Card Authorization Form - Fill Out and. Step 2 – Read over the introductory paragraph to ensure that you’re aware of what it is you’re authorizing. **Submit this form together with a photocopy of cardholder's credit card, front and back, make sure to mask out the CVV. Complete a blank sample5 Weeks of Incredible Deals. But for the security of the payee we do require a signed credit authorization form, copy of the credit card and. 720 9th Street, Room 101 . Download the BPI Cards Authorization form. Step 2 – The first step is to enter in the name of the Four Seasons property at which you have a room reserved. Edit your doubletree by hilton credit card authorization form online. Credit card authorization forms are used for recurring payments and also for one-time payments where charges will be incurred in the future. You do not have to process payments with Square to use these templates. 02. If you know in advance that you will be arriving late, please make a note of this in the "Special requests" section of the reservation form. Delete your la quinta credit card authorization online. Easily fill out PDF blank, edit, and sign them. Off Highway 78 near beautiful beaches and downtown San Diego. We do an authorization on Credit card at check in and it is removed in 24 hours. A credit card hold should be removed within 24 hours after you check out. Open the PDF form in a PDF reader, such as Adobe Acrobat Reader. SXSW Housing & Travel sends hotel reservations to our hotels in mid to late February. This is a common procedure that applies especially when an individual. La Quinta Inn & Suites by Wyndham Springfield MA: Beware of deposit fee you have to pay - See 1,038 traveler reviews, 139 candid photos, and great deals for La Quinta Inn & Suites by Wyndham Springfield MA at Tripadvisor. This form will also be kept on file to serve as credit card authorization for all other travel arrangements made with L & B Travel, LLC. 00. Save or instantly send your ready documents. Sale Price $1. through “EFS-Web” or any other USPTO Web site. You can furthermore download it, export is or print it out. Amount:Please note: If you had a La Quinta Returns® account, your former La Quinta Returns login credentials will no longer work. All of the codes will expire six (6) months of the date of issuance to Customer or at the date. La quinta credit card authorization form. On the Customer credit cards page, enter credit card information for. please email this form and photocopies to [email protected] choicehotels. The City Clerk’s Department has created this page to help you locate some of these official forms. Rewards Rate. New! Road Trip Planner. 23 ratings. 66, an overcharge amount of $557. Check back each week to discover new offers for travel, shopping, and more—plus, an exciting sweepstakes to win awesome prizes. Edit your billing disputes citi com online. 54-320 Southern Hills La Quinta, CA 92253 Or e-mail to: chrisf@pgawest. Click the New Document option. Obtain the Marriott credit card authorization form. The best way to edit La quinta bank card. Answers to the questions that Choice Hotels receive most often from our Internet guests. However, my debit card was charged a total of $4,431. La Quinta Inn & Suites. Hotels aren't the only kind of merchant to use pre-authorization holds to ensure funds for a potential charge, but they typically hang. This form requires that you identify the purpose of the trip, the expenses to be paid for by UNC, and that you obtain the. Follow the step-by-step instructions below to design your sheraton hotel credit card: Select the document you want to sign and click Upload. 01. Provide your financial information including your income, employment details, and any existing loans or credit cards you have. Completing La Quinta Credit Card Authorization Form 2020-2023 online with US Legal Forms. Enter Authorization Code and Card Details Enter Authorization Code. All reservations that are guaranteed with a credit card are held for late arrivals. Step 1 – If you’ve chosen to submit your credit card authorization via fax, download the form in either Adobe PDF or Microsoft Word (. CREDIT CARD AUTHORIZATION Please complete the form as completely as possible. Follow the step-by-step instructions below to design your days inn credit card: Select the document you want to sign and click Upload. Securely download your document with other editable templates, any time, with PDFfiller. Follow the step-by-step instructions below to design your marriott credit card authorization: Select the document you want to sign and click Upload. This template uses our PCI-compliant Card on File feature to securely store card information with your payment provider (either Stripe or Square). Mode Change to Reinstatement Policy Owner T h et Ca rdol Policy No. 10,000,000+ 303. be ready to get more. Get the fillable fields real put the requested info. It can either be a one-time transaction or a charge that keeps recurring weekly, monthly, or yearly. Enjoy ample amenities and a prime southeastern Florida location at La Quinta ® by Wyndham Miami Lakes. ), confirming that the cardholder has enough funds or available credit to cover a transaction they're making with their card. 03. Complete a blank sample electronically to save yourself time and Benefits: Wyndham Rewards Gold status, which includes free Wi-Fi, preferred room selection and late checkout. Our location north of downtown San Diego puts the city’s top sights within easy reach—from the San Diego. I understand that this form constitutes a legally binding contract and that by affixing my signature to this form, I will be held. The following information is needed to complete the. A Credit Card Authorization Form is a document containing a cardholder’s credit card information, typically issued by a business owner or a third party, which registers a cardholder’s consent to a future charge on their credit card for a period specified on the document. Please call Wyndham Rewards Member Services at (844) 405-4141When you book a stay at a hotel, you may notice a large hold on your credit card account as a pending charge. Rewards Rate. Personal information First name(s) / Surname(s). L. 5. SilverRock Resident Card; Facility Rentals; Report a Maintenance Issue - GoRequest; Public Safety Services. days inn check out. The group name and arrival date must be supplied here as well. 20 votes. DocHub Reviews. 01. The form is often used to give businesses the ongoing authority to charge the cardholder on a recurring basis — whether that’s. 4. To. In some cases, a hotel will accept a third-party credit card if an authorization form is completed and on file before check-in. VIEW RATES;An customizable or group wishing to pay for their keep by a In Quinta Hosts & Suites location to a loan bill other than their personalized will have to request a completed To Quinta hotel credit card authorization make first. Obtaining the customer’s approval with the form gives the merchant protection in the event a chargeback is initiated. A Travel Authorization ("TA") form must be completed for all UNC travel, regardless of whether UNC funds will be expended for the trip. Located off US-50, our hotel puts you near shops, restaurants, and museums. Report inappropriate content . Start. Please complete this form in its entirety, include all requested documentation, and fax it to the hotel at least 3 days prior to check-in to allow for processing. Additional Questions. FAX: 1-407-3513527, PHONE: 1-407-3513333. The attached Important Notice to Client/Disclaimer of. Obtain the credit card authorization form from the relevant institution or merchant. you may submit any comments concerning the accuracy of this burden estimate or make suggestions for reducing the burden to: u. 1. Basically, a credit card authorization form is used as proof the cardholder has the funds to cover the transaction that they are about to make. Save the modified document on your device, export it to the cloud, print. As a valued member of the Wyndham family, you have the opportunity to enjoy rates as low as $39/night* at participating Wyndham managed properties (below). Learn more. During your stay, enjoy great amenities like an. motel 6 cc authorization form. If you know in advance that you will be arriving late, please make a note of this in the "Special requests" section of the reservation form. No paper. See 442 traveler reviews, 393 candid photos, and great deals for La Quinta Inn & Suites by Wyndham Tampa Central, ranked #92 of 185 hotels in Tampa and rated 3. A credit card authorization form is a document that grants a business the authority to charge a customer's credit card without the buyer being physically present. Wyndham Collection 1175 Aviation Pl. 1615-0040 Expires 10/31/2025 START HERE - Type or. Step 1 – Download your form by downloading either the PDF version or the Microsoft Word version below. Non-compliance penalties start at $5,000 and can be as high as $500,000. Used a la quinta credit card authorization form template to make your paper workflow more streamlined. The form must contain the personal information of the consumer including their credit card or bank. The name of the group can be supplied next. Credit Card Authorization Form (PDF. This form will provide an avenue to report the payment information of the Credit Card that will be charged for the Reservation, the Identity of the Guest and the Cardholder, and where and when the desired Reservation is. Before the Supreme Court ruling, merchants won the right to add surcharges or. Learn more. Follow the step-by-step instructions below to design your best western credit card: Select the document you want to sign and click Upload. Email*. Complete La Quinta Total Card Authorization Form 2020-2023 online for OUR Legal Makes. 03. Credit Card Authorization Forms: *Click on the link to open the PDF and download or fill out the hotel’s online form. com or fax your form to 970-493-1826. Citizenship and Immigration Services USCIS Form I-765 OMB No. [1] Fair Credit Reporting Act Disclosure – This should be given to all individuals. Create your signature and click Ok. 15,005. Fill in the credit card information section with the appropriate details. 03. 538. Amount:Please note: If you had a La Quinta Returns® account, your former La Quinta Returns login credentials will no longer work. Student Success Center. If you are looking to draft such a form or familiarize yourself with one, these Sample Credit Card Authorization Forms should provide a blueprint. 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. University Medical Center, Covenant Hospital, and Lubbock Preston Smith International. Press Done. Features: 4. DISCLAIMER OF LIABILITY – The attached Important Notice to Client/Disclaimer of Liability is made a part of this Credit Card Authorization Form.