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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.

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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