Credit Card Authorization Form

To: Merchant name(网站名称)

Dear Sir,
Please be informed that I, ______________________________, hereby authorize Merchant name(网站
名称)(http://www.***.com/) or its subsidiaries to charge this bellow credit card for the amount below,
according to the card issue agreement and be responsible for 100% of the escrow fee in the event the
transaction is cancelled or the merchandise is returned.

Meanwhile, I also agree the followings:

1. to be bound by Merchant name’s (http://www. ***.com/) terms of use.
2. to be bound by escrow instructions for this transaction.
3. follow the instructions for the return of any merchandise.
Please find below the photos of my card:

Place Credit Card Here Copy of back of credit card showing your
signature

Remarks:
a) Kindly print this form and place credit card on box above and photocopy form.
b) Please block off the security code from your credit card.
Order Number: ________________________
Total Amount: ________________________
Card Number: ________________________________________________
Date: ________________________________________________
Signed by: ________________________________________________
 信用卡授权书

致：商户名称（网站名称）

亲爱的先生，

请知悉，本人 XXX 遵照发卡行协议，现授权向商户 名称（网站名称）

（HTTP：
//www.***.com/）

或其附属公司支付以下金额：____。若交易取消或商品退回，本人将自行承担全部服务费用。

同时，本人同意以下条款：

1. 遵守 XXX 商户使用条款（HTTP：// WWW *** COM /）

2. 遵守交易服务指示

3. 若要退货，遵守相应指示

卡照片如下所示：

请将信用卡放置此处 卡背面副本，请在卡面签字

备注：

一）请打印此表，并将信用卡至于表框中，后复印此表

二）请遮挡信用卡安全码

订单号：________________

总金额：________________

卡号：__________________

日期：__________________

签名：__________________