Credit Card Authorization Form

            




Complete the form below to submit your Terms & Payment Agreement.
Please enter your business information exactly as it should appear on your account. Fields marked with * are required.

Before you start

Use your legal business name and complete address.
Upload your resale certificate (DR-13 or equivalent), if applicable.
Accepted file types: PDF, JPG, PNG.




    
        

        
Terms Payment Agreement

        

            

                                                            

                            Business Name:                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Street Number                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Street Address:                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Location City Name:                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Location State Name:                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Location Zip Code:                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Location Suite # (if applicable):
                            

                                                                                                                                
                        
                                                                                

                            Attach Resale Certificate DR-13:                                    *
                                
                            

                                                                                                                                
                        
                                                
            
            

                
                
                    Submit Agreement
            
        
    
            





Need help?
If you have any issues completing the form or uploading a document, please contact us.


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By submitting this form, you confirm the information provided is accurate and authorized for your business.