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Authorization Form

Sign and complete this form to authorize The Design Fuzion to set up a payment with your

debit or credit card listed below.

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By signing this form you give us permission to debit your account for the amount indicated

on or after the indicated date. This is permission for a single transaction only and does not

provide authorization for any additional unrelated debits or credits to your account.

Credit Card Payment Authorization Form

Card Type

I authorize the above-named business to charge the credit card indicated in this authorization form according to the terms outlined

above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for

one-time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card

company; so long as the transaction corresponds to the terms indicated in this form.

Thanks for submitting!

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