Credit Card Authorization Request

Credit Card Authorization Request

This Credit Card Authorization Request (the Authorization) documents the agreement between the undersigned Cardholder and the Merchant for payment and related authorizations set forth below. By executing this Authorization the Cardholder grants the Merchant the right to charge the card identified herein in accordance with the terms and conditions set forth in this document.

WHEREAS

WHEREAS, the Merchant has provided or will provide goods and/or services to the Cardholder as described in the Scope of Authorization; and

WHEREAS, the Cardholder authorizes the Merchant to charge the credit card account identified below for amounts due in accordance with the Payment Terms; and

WHEREAS, the parties desire to set forth the terms governing the authorization, billing, and related confidentiality and remedies.

Scope of Authorization

Cardholder and Billing Information

Card Information

Payment Authorization and Terms

The Cardholder authorizes the Merchant to charge the card referenced above for the amounts and on the schedule set forth below. This authorization applies only to the transaction(s) described in this form unless otherwise expressly amended in writing by both parties.

Payment Terms (Legal)

The Cardholder agrees that the Merchant may charge the card for the amount specified above and for any additional amounts that are authorized in writing by the Cardholder. If recurring payments are selected the Cardholder authorizes each future charge in accordance with the schedule above until revoked in writing in accordance with the Term and Termination section. Charges will appear on the Cardholder’s statement as the Merchant’s name or designated billing descriptor.

Late fee: If any scheduled payment is not honored when presented or is delinquent, the Merchant may apply a late fee of of the past due amount or the maximum fee permitted by law, whichever is less. The Cardholder is responsible for all collection costs, including reasonable attorney fees, incurred by the Merchant to collect unpaid sums.

Refunds and adjustments, if any, will be made only in accordance with Merchant’s refund policy and applicable law. The Cardholder agrees to notify the Merchant in writing of any changes to the card account information or cancellation of this Authorization at least prior to the next scheduled charge. Merchant reserves the right to cease processing this authorization upon receipt of written cancellation and after reasonable time to effect cancellation.

Term and Termination

This Authorization becomes effective on and will remain in effect until unless earlier terminated by either party in accordance with the notice requirements set forth herein.

Either party may terminate this Authorization upon providing written notice to the other party at least days prior to the effective termination date. Termination does not relieve the Cardholder of liability for charges incurred prior to termination nor for authorized charges presented and processed prior to Merchant’s receipt of termination notice.

Confidentiality and Data Handling

Merchant will treat cardholder information as confidential and will use commercially reasonable administrative, physical, and technical safeguards to protect card data. Merchant may store cardholder account information only as necessary to effectuate recurring charges, and only in compliance with applicable card network rules and security practices. Merchant may disclose cardholder information as required by law or to its payment processor and agents for the purpose of processing transactions and collections.

Representations, Liability and Indemnity

The Cardholder represents and warrants that he or she is an authorized user of the card and has the authority to bind the account to charges authorized herein. The Cardholder agrees to indemnify and hold harmless the Merchant from any losses, costs or liabilities arising from Cardholder’s breach of this Authorization, including disputes arising from chargebacks where the Merchant is found to have complied with the terms of this Authorization.

Governing Law

This Authorization and any dispute arising hereunder shall be governed by and construed in accordance with the laws of the state or jurisdiction of the Merchant’s principal place of business, without regard to conflict of law principles.

Entire Agreement

This Authorization, together with any attachments or invoices expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior proposals, negotiations, or agreements, whether written or oral. No amendment to this Authorization will be effective unless in writing and signed by both parties.

Additional Information

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