Credit Card Authorization Form
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 either email it back to: retailcustomerservice@ice.com.
Our Credit Card Authorization Form
Date: _______________
Customer #: ______________
Customer Name: ________________
VISA ___ MasterCard ___ American Express ___
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)