b2c Authorization Form Template

This document is a credit card authorization form for candidates registering and paying for GCE exams with the British Council. It requests that candidates providing credit card payment information sign and return this form along with copies of their credit card, billing statement showing the last 4 digits of the card number, and photo ID. This enhanced procedure is being implemented to better protect customers' financial information and prevent credit card misuse when making online payments. Candidates must fill in their registration details, card holder information, and sign to authorize the payment and confirm they are the legal card holder.

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b2c Authorization Form Template

Uploaded by

shahina

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as DOCX, PDF, TXT or read online on Scribd

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Credit Card Authorisation form for Online Payments

Thank you for registering with British Council for the GCE exam. In order to provide greater reassurance to our
valued customers paying online by credit card we are enhancing our procedures with immediate effect.

As part of this change we request all candidates / clients paying for GCE exam by credit card to provide us with a
signed copy of this authorization form.

We understand that this extra procedure may be somewhat inconvenient, however these measures will help ensure
the protection of your financial information and also preventing credit card misuse.

Candidate Registration Reference number: __________________________________

Full Name:____________________________________________________________

City where you will take the exam: __________________

Payment date:_________________________________________________________

CARD HOLDER DECLARATION

Card Holder Name :_______________________________________________

Mailing address:___________________________________________________

Billing address:__________________________________________________

Country : _______________________________________________________

Phone number :__________________________________________________

E mail:_________________________________________________________

CREDIT CARD CONFIRMATION : ( Please select one of the following and make sure you have entered
correct information of the card which has been used for making payment)

□ Master Card ( last four digits of card #)

□ Visa Card ( last four digits of card #)

□ Debit Card ( last four digits of card #)

Issuing bank name ____________________________________________

□ Any other card applicable in our market ___________________________

(last four digits of card #)

I hereby confirm the following:

□ I am the legal card holder as per the details mentioned above
□ I am legal card holder as per the details confirmed above but give permission
to____________________________ (insert name of applicant)to use my card as indicated in the
Permission
of Use section . Once the order has been placed or services have been received, I will not proceed for

cancelation of the order.

Card holder signature:____________________________________________

Date:_________________________________________________________

ID REQUIREMENTS TO EMAIL OR FAX:

1. Copy of front and back of physical credit card. BLOCK OUT ALL but the last four digits of card #
.*This verifies you have the card
2. Copy of TOP ONLY of your billing statement .BLOCK OUT ALL but the last four digits of card #. This
verifies billing address /card owner`s name.
Copy of photo ID * this verifies your name /photo.