Credit Card Authorization Form

Welcome to the secure credit card authorization form for all SuperGroup companies, including Digitizing World, Budget Video Rentals, and Budget Video Repair.

IMPORTANT NOTICE ABOUT CREDIT CARD INFORMATION
Digitizing World accepts payments from many sources including credit cards. For anti-fraud reasons we do NOT SAVE credit card information from any transaction to be used again on any future transaction. Each and every credit card transaction is the final use of that credit card number. It is NOT saved in our databases. This keeps the information away from hackers or prying eyes. It also avoids any errors since you, our customer, must agree on a specific figure in writing (on a new authorization faxed, emailed, or sent from a PDA or the printed slip in our office).

STOP!

Before you fill out this form, use your camera phone, digital camera, or scanner to create four images:

- Front and Back of your Credit Card
- Front and Back of your Driver's License

At the end of this form, you'll be able to upload them and send them with your information. This MUST be done to validate your authorization!

NOTICE: Faxes and photocopies are NOT ACCEPTABLE


*required fields

*Quote/Contract/Invoice Number(s)
*Dollar Amount
$
 


*Name (as it appears on the credit card)
 

*Card Type
*Card Number (no dashes or spaces)
 
*Month
*Year
*CVM (what's this?)
 
Credit Card Bank information helps us protect you against fraud.
Please enter the Credit Card Bank Name and Phone Number in the fields below.
This information can usually be found on the back of the card.

*Bank Name (on card)
*Bank Phone (on card)
 


*Billing Address
 
*City
*State
*Country
*Zip
 

Phone
Fax
Mobile
 
*at least one contact phone number is required.

*Email Address
 


I hereby authorize Digitizing World/SuperGroup International to charge the above credit card for payment on this order.

*Digital Signature (what's this?)
*Date MM/DD/YYYY
 

Upload Images
Please attach your four JPEG images, in any order:
- Front and Back of your Credit Card
- Front and Back of your Driver's License