The Credit Card Payment Authorization Form is essential for businesses operating in Belgium that process credit card payments, whether for one-time or recurring transactions. This document is designed to comply with Belgian financial regulations, EU Payment Services Directive 2 (PSD2), and GDPR requirements, providing a secure and legally sound framework for obtaining payment authorization from cardholders. It is particularly relevant in today's digital economy where businesses need to ensure proper documentation of payment consent while protecting customer data. The form includes necessary provisions for strong customer authentication, data protection, and clear authorization terms, making it suitable for both physical and online transactions. It's commonly used across various industries for subscription services, recurring bills, automated payments, and one-time authorized charges.
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1. Cardholder Information: Essential identification details of the cardholder including full name, billing address, and contact information
2. Credit Card Details: Structured section for credit card information including card type, number, expiry date, and security code
3. Payment Authorization: Clear statement of authorization for charges, including maximum amount, frequency, and purpose of the payments
4. Duration of Authorization: Specification of how long the authorization remains valid and when it will expire
5. Cancellation Rights: Information about how and when the cardholder can cancel or modify the authorization
6. Data Protection Notice: GDPR-compliant statement about how the card data will be processed, stored, and protected
7. Signature Block: Space for date and signature, with clear statement of agreement to terms
1. Recurring Payment Details: Required only for recurring payment authorizations, specifying payment schedule and conditions
2. Multiple Card Authorization: Optional section for authorizing multiple cards, used when backup payment methods are required
3. Third Party Authorization: Required when the cardholder authorizes payments to be made to third parties or multiple beneficiaries
4. Variable Amount Authorization: Required when payment amounts may vary, specifying maximum limits and conditions for variations
5. International Payment Terms: Required for cross-border transactions, including currency conversion terms and international processing fees
1. Payment Schedule: Detailed breakdown of payment dates, amounts, and frequency (for recurring payments)
2. Fee Schedule: List of applicable fees, including processing fees, currency conversion fees, and any other charges
3. Privacy Notice: Detailed GDPR-compliant privacy notice explaining data processing practices and data subject rights
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