One Time Credit Card Authorization Form

Complete and sign this form to authorize New Material Culture Inc. to make a onetime debit to your credit card listed below. A 3% service charge is automatically added to all credit card payments.

*** Credit card transactions will not be accepted for international clients ***

Please complete the information below:

Your Name:(Required)

Email(Required)

Phone(Required)

Amount to be charged(Required)

The amount you authorize to be debited from your account.

Service Fee

A 3% Service Fee will be added to your total.

Price: $0.00

Auction Invoice #(Required)

The Material Culture Auction invoice #

Credit Card(Required)

(US Credit Cards Only)

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Signature/Consent

Authorization(Required)

By checking this checkbox, I authorize New Material Culture Inc. to charge my credit card for the specified invoice amount, as outlined in the agreement above. I confirm that I am an authorized user of the credit card and will not dispute the payment with my credit card company, provided that the transaction adheres to the terms in this form.

Signature (type your name)(Required)

Date(Required)

You have authorized us to charge your card in the amount of (amount+3% service fee):

Name

This field is for validation purposes and should be left unchanged.