Authority to Charge Credit Card

Business Name

Please use the business name as it appears on your invoice or activity statement

Business Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please select the Goods and Services to be charged against the nominated Card

SAAS / Licensing / Support
Hardware
Consumables
On-Site / Remote Technical Services

Card Type

Card Holder Name ( as shown on the credit card )

Card Business Number

Card Number

Card CVN

Expiry Month

Expiry Year

The Agreement

The undersigned has the authority to grant YumaPOS / YumaPAY ( PGTA Pty Ltd ) the right to charge the above Credit Card for the above Goods & Services provided to the above Business Trading Name.

The undersigned has granted YumaPOS / YumaPAY ( PGTA Pty Ltd ) the right to charge the nominated card for the nominated purchases including the cost to process and recover such amounts.

The undersigned may revoke this authority by giving 14 days notice in email to support@yumapos.com.au. Revocation of the Authority to Charge Credit Card will not operate to revoke this Authority with respect to liabilities arising before the date of the end of the 14 day period.

The laws of Western Australia will dictate the resolution of any disputes related to this Agreement.

Executed as a Deed

The undersigned has/have read, understand and agree to be bound by this Agreement

Name

First

Last

Signature

Clear Signature

Date / Time

Date

Time

Send a copy to my email address