Credit Card Authorization Form

ICE Data Services -

If you would like to change the credit card for billing you may do so online via Account Maintenance.

If you'd like a 3rd party to pay your bill, please have the card owner print this form, complete and sign it and email it back to: retailcustomerservice@ice.com.

PLEASE COPY AND FILL OUT THE FORM BELOW


Date: _______________

Customer ID #: ______________ 

Customer Name: ________________

VISA ___  MasterCard ___  American Express ___  Discover ___

CC# ________ ________ ________ ________ / Expires: ________ 

Select all that apply:
________ I will be paying my own account.
I hereby authorize you, until cancelled by me in writing, to charge my credit card account indicated above for all payables to ICE Data Services under my quotation service subscription agreement. 

________ I will be paying on behalf of the ICE Data Services customer mentioned above.
I hereby authorize you, until cancelled by me in writing, to charge my credit card account indicated above for all payables to ICE Data Services.

________ I hereby authorize you to take a one time payment in the amount of $_________ to be applied to the above mentioned account.

 

 

Cardholder's Name: _______________________________
 
Authorized Signature: _____________________________
 
Daytime Phone Number: ____________________
(in case we have questions)