Credit Card Authorization Form

Name of cardholder:
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Billing Address :

Address:
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City :
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States:
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Country:
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Zipcode:
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Cell Phone Number
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Card Type :
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Other Card Type :
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Card Number:
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CVV / CID
Visa, Mastercard and Discover credit cards is a three-digit number on the back,The American Express CID is on the front of the card above the account number
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Expiration date:
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Authorization Valid Until:
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I_( YOUR NAME ) , hereby authorize Honolulu Nails & Aesthetics Academy to charge my credit card for: (STUDENT'S NAME)
Please fill out your name and student name the boxes below :
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I certified that, all the given information is correct:
your signature here
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Certified Date
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