Escrow.com - Credit Card Authorization Form

Credit Card Authorization Form

•	To prevent the unauthorized use of your credit card. Escrow.com requires this authorization form to be completed.
•	Print this form.
•	Place credit card on box below and photocopy form. Please block off the security code from your credit card.
•	Authorize the charges to your credit card by signing below.
•	Fax signed form to 1-949-790-5801. No cover sheet is required.

Place Credit Card Here

Copy of ID showing your signature
OR
Copy of back of credit card

Transaction #:	________________________
Item Description:	________________________________________________
Total Amount:	________________________
Card Number:	________________________________________________
Date:	11/20/2009

I agree to pay the total amount as entered above according to the card issuer agreement. I hereby authorize Escrow.com or its subsidiaries to charge the above credit card for this amount. I agree to be bound by Escrow.com's terms of use and escrow instructions for this transaction, and agree to follow the instructions for the return of any merchandise. I also agree that the buyer is responsible for 100% of the escrow fee in the event the transaction is cancelled or the merchandise is returned.

Signed:	________________________________________________
Cardholder:	________________________________________________

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