Payment Authorization Form Authorization Form Customer Information Customer Information First name * Last name * Company name * Email * Phone Billing address * City * State * ZIP * Credit Card Payment Information Card Number * Expiration (MM/YYYY) * CVC Code * Section By submitting this form, I certify that I am an authorized user of this credit card. As the cardholder, or corporate officer, I understand that I am authorizing My Content Company to charge this card for services rendered. I understand that I am responsible for any additional charges that may arise from my credit card company and am responsible for informing My Content Company of any changes to this form of payment immediately. Submit