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Credit Card Authorization
Credit Card Authorization
jmunro
2020-12-19T01:11:43+00:00
Credit Card Authorization Form
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Job #
*
Invoice #
Company Name
Individuals Name
*
First
Last
Phone
*
Email
*
Credit Card Billing Information
Type Of Credit Card (Please Check One)
*
American Express
Master Card
Visa
Discover
Dollar Amount To Be Charged:
*
Name On Credit Card:
*
First
Last
Credit Card Number:
*
Expiration Date:
*
Verification Code (Three or four digits on back signature panel or front of card):
*
Card Billing Address:
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone (If Different Then Above)
Email Receipt (If Different Then Above)
Agreement:
Agreement: This agreement is entered by the above-named client and Munro Enterprises, LLC. Client acknowledges that the name printed above is the name as it reads on the credit card, and the signature below is the authorizing signature for this credit card. Client authorizes Munro Enterprises, LLC. to charge the above credit card for all security deposit(s) and charges resulting from Rental Contract. Client must either sign for all equipment or list users below who can sign on Client’s behalf. Client’s (or authorized users) signature or Rental Contract is acknowledgment for the receipt of all equipment and services stated. Client agrees to abide by Munro Enterprises, LLC. rental Terms & Conditions and agrees to pay all fees stated (including charges resulting from, but not limited to, lost or damaged equipment and additional use charges). A one (1) day rental will be charged if cancellation notice is not received one (1) week prior to event date regardless of equipment delivery.
Additional Authorized Account User:
Additional Authorized Account User:
Card Holders Digital Signature: (Please Use Your Finger/Mouse To Sign)
*
Todays Date:
*
Message
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