Recurring Credit Card Authorization Form

Create a high quality document online now!

Updated April 20, 2022

A recurring credit card authorization form is a document that will authorize a company to automatically deduct payment (i.e. utility bills, various subscriptions, automobile payments, etc.) from an individual’s credit card account. The payments will be charged at the end of each billing cycle. By providing permission for recurring payments, you will be charged on or around the same time each month. The charges will end when the purchase has been paid in full or if permission is removed by the cardholder.

Table of Contents

What is a Recurring Payment?

A recurring payment is commonly made on a weekly or monthly basis. This is common especially for gym memberships, software subscriptions, and any other repeating payment authorizations.

How to Setup a Recurring Payment

There are two ways in which a company can accept a recurring credit card payment; when a customer is physically present or when a customer lands on a business’s website online. In either case, any business charging recurring credit card payments will need accounting software such as Quickbooks that can generate reports and track customer transactions.


The traditional route and most widely used format before the internet arrived. For gym businesses, this is standard procedure as every gym tries to lock their customers’ into a recurring monthly credit card payment. In order to legally accept a recurring credit card payment from a customer in person, the business must obtain the signature of the customer. Once complete, the business should retain the form in their records for as long as the person is a customer.


The advantage of offering a recurring credit card payment online is that it’s far easier to do so and less paperwork. Most websites only require their customers to read a “Terms of Service” or click an “Accept Terms” button which gives the company the legal right to charge a recurring credit card payment if the purchase is made. Companies who offer a service online can also offer a free trial, which if the customer does not cancel, allows the company to go forth with a recurring payment after the free trial ends.

Canceling a Recurring Payment

In most cases, canceling recurring credit card payments can be done easily online. For other businesses, it may need to be done over the phone or by signing a consent form. If you are unaware of the business, there is commonly a phone number listed on your billing statement. Otherwise, searching the name of the payment description into Google is your best bet for finding the merchant.

How to Write

Download: Adobe PDF, MS Word (.docx), OpenDocument

1 – Use The Document On This Page To Set Up A Recurring Credit Card Payment

The paperwork on this page can be downloaded through the buttons provided with the image or the links above. Notice that three buttons are displayed so that you may download this authorization template as a PDF or word processing document.

2 – Identify Yourself And The Concerned Merchant

The first paragraph contains the wording required to authorize the same credit card payment to a specific Merchant on a regular basis. Just below this initial paragraph, you will need to supplement a statement with some important information. Begin by entering your name on the blank line labeled “Cardholder’s Name.” Make sure you present this item exactly as it appears on your credit card. On the blank line labeled “Merchant’s Name,” fill in the complete name of the Merchant (or vendor) that you will allow to charge your credit card on a regular basis in the future. This name should appear exactly as it does on the books. You must declare precisely how much the above Merchant can charge your card and how often this amount should be charged. Report the total amount of money the Merchant can charge you on the blank line after the dollar sign. Now you must indicate the frequency this payment amount may be withdrawn from your card by the Merchant. You can approve a payment made once a week, once a month, or any other period you choose provided you clearly document it. The blank line labeled “Day” will accept either the two-digit calendar day of the month you approve the concerned payment to be made, the day or the week, or any other due date. Naturally, we will need to indicate whether you are approving a weekly payment, monthly payment, quarterly payment, etc. by relating this information on the blank space labeled “Week, Month, Etc.” In the example below, we will set a recurring payment to be made by the credit card as occurring on the 2nd of every month. 

3 – You Must Supply Your Billing Information

In order for the Merchant and the Credit Card Company to allow this transaction to be made, you will need to supply further verification of your identity. You must enter the credentials requested in the “Billing Information” exactly as they appear on your credit card bill. The space labeled “Billing Address” is reserved for the building number, street name, and (if applicable) the apartment number listed in your billing address. Just below this line, the “City, State, Zip” requires the remainder of your billing address reported on it. Some additional information required will serve to both verify your identity and provide an immediate method of contact that the Merchant or Credit Card Company can use to contact you fairly quickly. Present a well-maintained “Phone #” and “Email” address these entities can use to contact you when necessary. Make sure these items are accurate and up to date.

4 – Detail The Credit Card Being Used

In addition to the information you have documented above, this paperwork will require the specifics of the credit card you wish the Merchant to withdraw funds from. This requirement can be satisfied in the section titled “Card Details.” The first task here will be to mark the box labeled “Visa,” “MasterCard,” “Discover,” or “American Express” to disclose the type of credit card that should be used by the Merchant. In the example below, the Cardholder will be using an American Express. Next, report the full name of the individual who this credit card considers the holder of this account on the blank space labeled “Cardholder Name.”  Record the full account or credit card number you wish the funds to be withdrawn from on the next line (“Account/CC Number”).  Nex Next, record the “Expiration Date” of this credit card as a two-digit month and two-digit year on the pre-formatted spaces below the credit card number you recorded.  Most, if not all, credit cards will have a card verification value on the back of the card by the signature area. Typically, this is a three-digit number (however it can be up to four). You must present this number on the blank space labeled “CVV.” Finally, enter the “Zip Code” used in the billing address for the credit card you are documenting on the blank space labeled “Zip Code.”

5 – Only A Your Authorizing Signature Will Put This Document In Effect

The final paragraph of this template will require one last item of preparation before you can sign it. Supplement this binding statement with the name of the Merchant that will withdraw funds from your credit card on the blank space just after the words “…I Agree To Notify.” You must sign your name to the signature line labeled “Cardholder’s Signature” then enter the current calendar date on the adjacent line (“Date”).