Payment Authorization Form

Merchant Name

Amorio Technologies

Merchant Business Address

No: 5634, Route 38, Pennsauken,
New Jersey,08109, United States.

Merchant Business Phone Number

+1 (908) 458-6464

Business Email Address

sales@amoriotech.com

I, Angel Spa Nail Authorize Amorio Technologies to charge my *

Credit Card

Debit Card

Checking Account

Savings Account

On a [one-time / recurring basis] as payment for*

Credit Card Information - if charging a credit or debit card

Card Type*

Master Card

Visa

American Express

Discover

Other

Other Card

Name (As it appears on the card): *

Card Number: *

Expiration date (MM/YYYY): *

*Please note, you will be contacted via the phone number you provided to request for your card CVV in compliance of PCI standards

Bank Account Information - if charging a checking or savings account

Card Type*

Account Name *

Account Number *

Routing Number *

Billing address*

Zip Code*

Contact Number*

Email Address*

Date *

I certify that I am the owner of the credit card indicated above and will not dispute the scheduled payment with my bank/credit card company; provided that the transactions match with the terms described on this authorization form.
For recurring transactions, I understand that my information will be saved to file for future transactions on my account and authorization will remain in effect until I formally request cancellation.

Your Digital Signature *

Clear

Customer Signature Upload