Credit Card Authorization Form

I/We hereby authorize SecureSearch Background Checks to utilize and charge said credit card for all activity billable for SecureSearch Background Checks. Any debit/credit card changes need to be submitted to SecureSearch Background Checks via this form.

Organization Name: Enter your Organization name

Name as it appears on card:
Invalid Input

CC Number: Please double check that there are no dashes or spaces. 16 digits are required for Visa/MasterCard/Discover and 15 digits for AMEX.
Exp. Date:
Security Code:

Credit Card Billing Address

Authorized By:
Please enter your name in the signature line.
Your Name
Invalid Input
Today's Date:
Please enter valid email.
Contact Email
Invalid Input
Effective Date: Please enter the date
Is this change for credit card Holder only? Invalid Input
Is this person the new invoicing Contact? Invalid Input