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The form requests cardholder details exactly as printed on the credit card, including account number, CVV, expiration date, billing address, and contact information. 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Your analytical report(s) will be forwarded along with your invoice. Return this form with a copy of front and back the credit [card provided to billing@irislaboratories.com](card provided to billing@irislaboratories.com).  \nThe information provided below must be printed clearly and exactly how it appears on your credit card. If you have any questions, please contact our office at (908) 206-0073.  \n\n| Company or Individual Name: |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  | \u003Cbr>Visa |  | |  |  |  |  | |  |\n|  |  |  |  |  |  |  | Master Card |  |  |  | Amex |  |  |\n| Name on Credit Card: |  |  |  | Credit Card No. |  |  |  |  |  |  |  |  |  |\n| CVV Code: |  |  |  | Expiration Date: |  |  |  |  |  |  |  |  |  |\n| C.C. Billing Address: |  |  |  | City, State: |  |  |  |  |  | Zip Code: |  |  |  |\n| Cardholder Signature: |  |  |  | Cardholder Phone No.: |  |  |  |  |  |  |  |  |  |\n| Please Check one: | | New card on file | | Replace card on file |  |  |  |  |  |  |  |  |  |\n| E-mail: |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\nBy signing this form and providing your credit card number, you acknowledge the card number and information on the card is valid, and was not obtained fraudulently. You authorize IRIS Laboratories to receive payment for analytical services from the credit card company in accordance with the invoice(s) . Any disputes regarding quoted prices, results or other testing issues must be submitted in writing to the IRIS support team, or management for resolution within 30 days of invoice date. Our policy is to offer in-house credit only for analytical results provided by IRIS under the terms negotiated. No Cash Refunds. Cardholder is responsible for updating the credit card information as necessary.  \n\n| I have read and understand IRIS’s terms and conditions for credit card use stated above, and: |  |\n| --- | --- |\n| | I authorize IRIS Environmental Laboratories, LLC., to automatically charge my credit card for every invoice. |\n| Signature:  Date:  |  |","cbCaifOawrhEgviI","https://ap.wps.com/l/cbCaifOawrhEgviI","pdf",170916,"English","# Credit card retention and automatic invoicing\n# Cardholder information required\n## Payment card details\n## Billing address and contact\n# Card option selection and signature","[{\"question\":\"What does signing this form authorize IRIS Laboratories to do?\",\"answer\":\"It authorizes IRIS Laboratories to retain your credit card on file and automatically charge it for each invoice for analytical services.\"},{\"question\":\"What information must be entered exactly as shown on the credit card?\",\"answer\":\"The form requires the card details to be printed clearly and exactly as they appear on the credit card, including the name on the card, credit card number, CVV code, and expiration date.\"},{\"question\":\"How long do you have to submit disputes about pricing or testing results?\",\"answer\":\"Any disputes regarding quoted prices, results, or testing issues must be submitted in writing to the IRIS support team or management within 30 days of the invoice date.\"}]","Credit Card Authorization Form - 2025 - Application | PDF"]