Recurring Payment Authorization Form Template

RECURRING PAYMENT AUTHORIZATION FORM TEMPLATE FAQ

What is a recurring payment authorization form?

A Recurring Payment Authorization Form is a written permission that allows a business or service provider to charge a customer’s payment method automatically on a set schedule. It is commonly used for subscriptions, memberships, retainers, installment plans, and ongoing services.

What should the form include?

It should include: customer name, payment method details, amount and frequency, start date, billing descriptor (optional), what charges are covered, cancellation rules, and how to update payment information. This template includes both fixed-amount and variable-amount options.

Can the amount change each billing cycle?

Yes, for usage-based or variable billing. If the amount can change, the authorization should clearly state how amounts are calculated and how notice will be given. This template includes a “variable amount” option and a notice section.

How can the customer cancel?

Cancellation terms should be written clearly (notice method, timing, and any final charge). This template includes simple cancellation language and a space for a policy link or written terms.

Is an electronic signature allowed?

Often yes, depending on local law and the payment processor’s requirements. This template includes a checkbox for e-signature acceptance.

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