Credit Card Authorization

                                            CUSTOM PROP RENTALS

                                      CREDIT CARD AUTHORIZATION

Billing Information

Company Name:_____________________________________________

Name:_______________________   

Phone Number: ___________________________

Email: __________________________________________________

Address:________________________________________________________ City: ____________________ State: _______ Zip Code:___________

Shipping Information (Check if same as billing) □

Company Name:__________________________________________

Name:_______________________

Phone Number: ______________________

Email: ______________________________________

Address:________________________________________________________ City: _______________ State:________________ Zip Code __________

ATTENTION

Any Major damage will be examined and charged at the time of return. ➢ Please attach a copy of a valid ID and a copy of the card bellow.

Credit Card Details

Cardholder Name:____________________________

Card Number:___________________________________________________

Security Code: ______________ Expiration Date: _____/_____ 

____________________________ Authorize Custom Prop Rentals to charge the above credit card, if necessary, under the circumstances that the original terms and conditions related to this rental transaction are broken on or after the date ________ /________ /_________. I also certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in these form.

Signature:_______________________________

Print:___________________________