Credit Card Authorization Form

Do you consistently order your videos from us?
We’ve made onsite ordering even easier!
Complete this form to authorize EquiMotion Media to securely store your card information through Square, a PCI DSS Level 1 compliant payment processor operated by Block, Inc.
Your card will be stored securely for future purchases, and only the last four digits will be retained by EquiMotion Media for verification purposes.

Please note: Accounts created through our website are not linked to our in-person payment system. Any cards stored online are not accessible to EquiMotion Media for onsite or manual orders.

Card Type

MasterCard

VISA

Discover

AMEX

Name (as shown on card)

First Name

Last Name

Phone

(###)

###

####

Last four digits of card number

Expiration Date (mm/yy)

Cardholder ZIP Code (from credit card billing address)

How would you prefer to provide your full card information for secure storage in Square?

I will provide it in person at the next event

I would like to provide it via phone call

I authorize EquiMotion Media to store my name, ZIP code, expiration date, and the last four digits of my credit card for verification and transaction matching purposes. Full card details are securely stored by Square, a PCI DSS Level 1 compliant payment processor operated by Block, Inc.

I agree that my typed name serves as my legal electronic signature and I consent to the storage of this information for future purchases.