Customer Application

            
     




Credit Card Authorization Form — One-Time Payment or Card on File
Complete and sign this form to authorize USA Hospitality, Inc. to charge a credit card for approved purchases. You may choose a one-time payment or authorize USA Hospitality to keep card on file for future invoice payments (as selected below). Fields marked with * are required.




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Official USA Hospitality credit card authorization form to approve card payments (one-time or card-on-file). Includes required ID verification and Orange County, Florida terms.


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Required documents (to protect the cardholder and the business)

Credit card: front and back (do not send PINs).
Cardholder ID: U.S. driver license/state ID or international passport.
Signature: authorized cardholder signature required (digital signature accepted).

Security note: Provide only what is requested. Never include card PINs. Do not email card details in open email threads—use this secure form submission whenever available.

 

Credit card authorization terms & acknowledgments (Orange County, Florida)
By completing and submitting this Credit Card Authorization Form, the Applicant and/or Cardholder (“you”) authorizes USA Hospitality, Inc. (“USA Hospitality”) to charge the credit card provided for payment of approved purchases, invoices, deposits, delivery releases, or other agreed charges associated with goods and services provided by USA Hospitality. You acknowledge that this authorization is provided for legitimate business purposes and may be relied upon by USA Hospitality in processing card payments.

Authorization scope: I authorize USA Hospitality to charge my card for the payment option selected in this form (one-time payment and/or card-on-file for future payments), limited to charges that I approve or that correspond to invoice(s) and terms indicated herein.
Identity verification: I understand USA Hospitality may require identification and supporting documentation (card images and ID) to reduce fraud and ensure the Cardholder is authorized.
Receipts and records: I agree that transaction receipts and confirmations may be delivered electronically to the email address provided, and that electronic records are acceptable for accounting and audit purposes.
Card-on-file cancellation: If I choose card-on-file, I understand this authorization remains in effect until I cancel it in writing. I agree to provide written notice of cancellation or card changes at least fifteen (15) days before the next scheduled or expected charge.
Disputes and good-faith resolution: I agree to contact USA Hospitality first to resolve billing questions in good faith before initiating a chargeback, provided the transaction(s) correspond to the authorization and invoice(s) described in this form.
Compliance: I acknowledge that card processing and storage practices are subject to applicable U.S. law and industry requirements (including PCI-related procedures), and that USA Hospitality processes payments through secure merchant services providers.
Venue: I acknowledge that disputes related to this authorization may be brought in the appropriate court in Orange County, Florida, unless otherwise required by applicable law.

Important: Charges may be declined if bank/issuer verification fails or documentation is incomplete. Incorrect card details may delay order release.

 

Upload examples (visual guidance)


Credit Card — Front (sample)




Credit Card — Back (sample)




U.S. Driver License / State ID (sample)




International Passport (sample)



Tip: Upload clear images. Ensure the card number and name are readable. You may cover the CVV if your policy requires it; however, USA Hospitality may request additional verification if needed for fraud prevention.


By submitting this authorization, you confirm you are authorized to act on behalf of the Applicant/Cardholder and that the information provided is accurate.




    
        

        
Credit Card Authorization Form

        

            

                                                            

                            I authorize USA Hospitality, Inc. to securely keep this credit card on file and charge it for future payments, including pre-payment of open invoices prior to delivery, until this authorization is revoked in writing.                                    *
                                
                            

                                                                     YES NO                                                            
                        
                                                                                

                            If not authorized to place credit card on file, provide INVOICE(S) NUMBER(S)::
                            

                                                                                                                                
                        
                                                                                

                            If not authorized to keep credit card on file, provide total amount authorized to be paid:
                            

                                                                                                                                
                        
                                                                                

                            Upload Credit Card (Front)                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Attach Front of Credit Card                                    *
                                
                            

                                                                     I had attached the front of my card.                                                            
                        
                                                                                

                            Upload Credit Card (Back)                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Attach Back of the Credit Card                                    *
                                
                            

                                                                     I had attached the back of my credit card.                                                            
                        
                                                                                

                            Type of ID to be verified?                                    *
                                
                            

                                                                     Driver's Lisence Passport                                                            
                        
                                                                                

                            Upload Driver’s License (Front)
                            

                                                                                                                                
                        
                                                                                

                            Attach here the front of the ID                                    *
                                
                            

                                                                     I had attached my ID                                                            
                        
                                                                                

                            ID Number:                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Attach Passport Page (if applicable)
                            

                                                                                                                                
                        
                                                                                

                            Passport Number (if applicable)
                            

                                                                                                                                
                        
                                                                                

                            Business Name                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Contact  Name                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Phone Number                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Business Contact Email                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Card Holder Full Name                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Billing  Address Street Number                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Billing Address Street Name                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Billing Zip Code                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Card Type                                    *
                                
                            

                                                                     Visa MasterCard American Express Discover Diners                                                            
                        
                                                                                

                            Card Expiration MM/YY                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Card Number                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Secuity Code CVC                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            I certify I am authorized to use this credit card and authorize USA Hospitality, Inc. to charge this card for approved purchases.                                    *
                                
                            

                                                                     I agree                                                            
                        
                                                                                

                            Signature (Type Full Name)                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Signature Date                                    *
                                
                            

                                                                                                                                
                        
                                                                                

                            Captcha                                    *
                                
                            

                                                                    
                                                            
                        
                                                
            
            

                
                
                    Submit Credit Card Authorization
            
        
    
            

Need help?
If you have any issues completing this form or uploading documents, please contact our team.
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By submitting this form, you confirm you are authorized to use the card provided and authorize charges according to the selection made (one-time or card on file).