AOR Secure Credit Card Intake

Star (*) indicates required field.

Client/Company Name*
Credit Card Type*
Credit Card Number*
Name On Card*
Billing Address Line 1*
Billing Address Line 2
Billing City*
Billing State*
Billing Zip*
Please choose your 'forget by' preference*
AOR is authorized to use this card for...
Specify Invoice Numbers (If Applicable)

We are fully compliant with PCI DSS v3.2 for the payment-related data we collect from you but we have no plans to obtain a PCI Report-on-Compliance due to the limited use of credit card payments.