Are you the merchant or the customer? Are you the merchant or the customer? MerchantCustomer Do you want a completed form or a blank template? Do you want a completed form or a blank template? Blank template to use for multiple customers.Completed form for a specific customer. Type of Authorization Type of Authorization Credit CardBank Transfer (ACH) Is this for a single payment? Is this for a single payment? One paymentRepeating payments (monthly or yearly, etc.) Charge Amount $ Enter only numbers. The decimal will appear automatically. When will the charge be made? Leave this blank to enter it by hand later. The first charge is on: When will the charges start? What are the charges for? Leave this blank to enter it by hand later. Will the customer pay a fee if the payment is rejected? (NSF fee) Will the customer pay a fee if the payment is rejected? (NSF fee) Yes (this is most common)No The customer pays a fee if the bank cancels their payment for lack of funds. Fee Amount $ Merchant Name Customer Name Next Save Save and finish later
