Credit Card Authorization

  • MM slash DD slash YYYY
  • Month / Year
  • Authorization

    By completing the information below I hereby authorize Southwest Processors, Inc. to hold the above Credit Card on file, for future payment on charges to my account. I am aware that I will receive a copy of the charge slip and that this slip will act as my record of this transaction Charge mentioned on your statement will appear as Southwest Processors, Inc.
  • MM slash DD slash YYYY

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