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Credit / Debit Card Authorization Form

Payment can be made remotely by filling out our credit card authorization form:

  1. Download and complete the credit / debit card authorization form. We recommend you do this on your computer, but you can also screenshot and complete via mobile device.

  2. Don't forget to scan or take a photo of your ID, front of card and back of card!

  3. Email the form along with images (ID, front of card, back of card) to your sales rep or info@nextarusa.com. If you'd like for us to keep your card on file, please do not initial the section for one time use only.

  4. Your sales rep or someone from our team will confirm receipt and send you your invoice once the transaction is complete.

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