Credit Card Authorization Form
Get written permission to charge a card on file, with the amount, the schedule, and a drawn signature, without collecting the card number itself.
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- Fields
- 14 questions
- Layout
- Classic, every question on one page
- Theme
- Slate, switchable in the preview
- Updated
- 10 September 2026
Categories
- Finance form templates
- Payment Forms
- Authorization Forms
- Finance Forms
Form type
Ideal for
- Subscription businesses
- Agencies
- Property managers
- Clinics
Best used in
- Client onboarding
- Recurring billing
- Retainer agreements
About this template
A credit card authorisation form is the written permission you keep on file before charging someone repeatedly, or before charging a card that is not present. It records who owns the card, what they agreed to, how much, how often, and from when. Without it, a disputed charge is your word against theirs, and the card networks tend not to side with the merchant who has nothing on paper.
The important design decision here is what this form does not ask for. There is no field for a full card number, no security code, and no expiry date. A general purpose form tool is the wrong place for any of them: the submission sits in a database, gets emailed around, and turns a routine form into a compliance problem. The form asks for the last four digits, which is enough to identify which card was authorised, and nothing more.
When you actually need to take the card, add a payment field instead. That hands the card straight to Stripe and never lets the number touch your submissions. Use this form for the authorisation and the signature, and the payment field for the money.
Adapt the checkbox wording to your own terms before publishing, set the currency list to the ones you take, and add a cancellation notice period if you require one.
Templates are a starting point, not legal or professional advice. Where a form carries consent, medical, or contractual wording, have somebody qualified review it against the rules that apply to you before you publish.
Fields in this template
- Cardholder name as printed on the card*Short text
- Email address*Email
- Phone numberPhone
- Billing address*Address
- Card brand*Dropdown
- Last four digits of the card*Short text
- Amount to charge*Number
- Currency*Dropdown
- How often*Single choice
- First charge on*Date
- What the charge is for*Long text
- Please confirm the following*Multiple choice
- Signature*Signature
- Date signed*Date
Every field can be renamed, reordered, made optional, or removed once the template is open in the builder.
Build this form by asking Claude or ChatGPT
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Frequently asked questions
- Should a credit card authorisation form collect the full card number?
- No. Storing a full card number, a security code, or an expiry date in a form submission puts you inside PCI scope and leaves the number sitting in a database, an inbox, and any export anyone has taken. This template asks for the last four digits, which identifies the card without carrying the risk. Take the card itself with a payment field, which passes it directly to Stripe.
- Is a signed authorisation form enough to charge a card?
- It is the evidence you need if the charge is questioned, but it is not the payment method. You still need a way to charge the card, whether that is a saved payment method in Stripe, a terminal, or your own gateway. Think of the form as the paperwork that justifies the charge rather than the thing that makes it happen.
- How long should I keep a credit card authorisation on file?
- Keep it for as long as the authorisation is live, and then for as long as a chargeback could still arrive against the last payment taken under it. Card networks generally allow cardholders to dispute for months after a transaction, so most businesses keep the signed form for a year or two past the final charge. Check the rules your acquirer applies.
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