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PCM Productions
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Credit Card Authorization Form
IMPORTANT INFORMATION ABOUT CREDIT CARD INFORMATION
PCM Productions accepts payments from many sources including credit cards. For anti-fraud reasons we do NOT SAVE credit card information from any transaction to be used again on any future transaction. Each and every credit card transaction is the final use of that credit card number. It is NOT saved in our databases. This keeps the information away from hackers or prying eyes. It also avoids any errors since you, our customer, must agree on a specific figure in writing (on a new authorization faxed, emailed, or sent from a PDA or the printed slip in our office).
STOP! Before you fill out this form, use your camera phone, digital camera, or scanner to create four images:
- Front and Back of your Credit Card
- Front and Back of your Driver's License
At the end of this form, you'll be able to upload them and send them with your information. This MUST be done to validate your authorization!
NOTICE: Faxes and photocopies are NOT ACCEPTABLE
Production Qoute/Contract/Invoice Number(s)
*
Dollar Amount
*
Name (as it appears on the credit card)
*
First
Last
Card Type
*
Visa
Mastercard
American Express
Discover Card
Card Number (no dashes or spaces)
*
Card Expiration Date (Month/Year)
*
Credit Card Bank information helps us protect you against fraud.
Please enter the
Credit Card Bank Name and Phone Number
in the fields below.
This information can usually be found on the back of the card.
CVM Number (3 digit code on back of card)
*
Bank Name (on card)
*
Bank Phone (on card)
*
-
-
Card Member Billing Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
-
-
*
at least one contact phone number is required.
Email Address
*
I hereby authorize PCM Productions to charge the above credit card for payment on this order, extensions of this order, a 4% credit card processing charge and missing or damaged items.
Digital Signature
*
Date MM/DD/YYYY
*
Upload Images
Please attach your four JPEG images, in any order:
- Front and Back of your Credit Card
- Front and Back of your Driver's License
Upload File
*
Max file size: 20MB
Upload File
*
Max file size: 20MB
Upload File
*
Max file size: 20MB
Upload File
*
Max file size: 20MB
Submit