Secure E-Signature

AMZORA Recurring Payment Authorization

By completing and signing this form, you authorize AMZORA to charge your designated payment method on a recurring (daily) basis for services rendered. Please review every section carefully before signing.

1. Client Information

Full legal identity for this authorization.

Full legal name *

Business / DBA name

Email *

Phone *

2. Billing Address

Must match the address on your payment method.

Street address *

Apt / Suite

City *

State / Region *

Postal code *

Country *

3. Payment Method

Choose how AMZORA should charge you.

Credit / Debit Card

Visa, Mastercard, Amex, Discover

Bank Account (ACH)

US checking or savings account

Payment details are transmitted securely. AMZORA stores only the last 4 digits of your account number for verification — never the full number.

Cardholder name *

Card number *

Exp month (MM) *

Exp year (YY) *

CVV *

4. Scope of Authorized Charges

Select the categories of charges you authorize.

AMZORA flat per-order fee — $10.00 USD per order (all-inclusive: shipping, storage, prep, labels, returns, and all related fulfillment services)

Billing frequencyDaily — Required

Charges run on a daily cadence. This is required and cannot be changed. The daily charge equals AMZORA's flat $10.00 USD per order(all-inclusive: shipping, storage, prep, labels, returns, and all related fulfillment services) multiplied by the number of orders shipped that day. An itemized invoice will be sent to you for each daily charge.

Retry policy for failed transactions

Default: 3 retry attempts over 72 hours after a decline. If the payment method is not resolved within 72 hours, the account will be paused until updated.

5. Terms & Acknowledgments

Each item must be acknowledged for this authorization to be valid.

Recurring charges authorized

I authorize AMZORA to initiate recurring (daily) charges to the payment method designated above for the services described in Section 4. This authorization will remain in effect until I revoke it in writing.

Flat per-order charge — $10.00 per order, daily

I understand AMZORA charges a flat all-inclusive rate of $10.00 USD per order, which covers shipping, storage, prep, labels, returns, and all related fulfillment services. The total daily charge equals $10.00 multiplied by the number of orders shipped that day, so the daily amount will vary by volume but the per-order rate is fixed. AMZORA will send me an itemized invoice for each daily charge.

24-hour decline / failed payment policy

If my card or bank account is declined, expired, or otherwise stops working, I have 24 hours from the time of notice to update my payment method. If the issue is not resolved within 24 hours, AMZORA may pause my account until the matter is resolved. I will not hold AMZORA liable for service interruption resulting from a failed payment method on my side.

Cancellation, refunds & disputes

I may revoke this authorization at any time by emailing AMZORA with at least 3 business days' notice prior to the next scheduled charge. Refund and dispute requests are governed by AMZORA's Terms of Service. I agree to contact AMZORA before initiating a chargeback. I have read and agree to AMZORA's broader Terms & Conditions.

E-signature consent (ESIGN Act)

I agree to use an electronic signature for this authorization, and that my electronic signature has the same legal effect as a handwritten signature under the U.S. ESIGN Act and applicable state law. I confirm I am authorized to use the payment method provided.

6. Signature

Sign below to make this authorization legally binding.

Signature *

Sign above using your mouse, finger, or stylus

Printed name *

Date *

AMZORA · Recurring Payment Authorization · Version 1.0
This authorization is stored securely. AMZORA complies with applicable PCI DSS requirements for card data and NACHA rules for ACH debits. Records are retained for the legally required period.

By clicking the button above, you confirm everything in this authorization is accurate.