Credit Card Authorization Form

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I authorize Background Info USA to charge my credit card for all orders placed under my account. I understand that if my credit card is declined for any reason, I will be charged a $25 late fee. In addition, my account will switch to pay as you order until a valid credit card is provided.

Credit Card Authorization

First Name

Last Name

Company Name

Email Address

Phone Number

Credit Card Type

Name on the Credit Card

(as it appears on the card)

Credit Card Number

(no dashes or spaces)

Expiration Date

(mm/yyyy)

Security Code

(3 numbers on the back of the card)

Billing Address

City

State/Province

Zip/Postal

I understand that typing my name below will serve as an electronic signature.

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Enter Today's Date

If you are human, leave this field blank.

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ABOUT US

Background Info USA provides simply better employment screening for you and your candidates.

HEADQUARTERS

9990 Coconut Road
Bonita Springs, FL, 34135