Payment Card Authorization Form

Payment card handlers and processors complete the Payment Card Authorization Form when a customer is not able to self-enter a payment card transaction.

The Payment Card Authorization Form is completed when the customer is present in-person or when the transaction is handled via phone.

Data collected on this form must be protected in accordance with university policy and the payment card industry standards.

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions, if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

      the appropriate UB fiscal processing office using a lock bag

Need Help Completing the Form?

Contact An Expert
Contact Email
Tricia Canty
Financial Management

Form Facts

Form Type: Fillable, Downloadable, PDF

Requirements: Adobe Acrobat

Updated: October 2019

Owner: Policy, Compliance and Internal Controls