Credit Card Authorization Form Credit Card Authorization Form COMPANY INFORMATION COMPANY: * **Company name must match the certificate of insurance** JOB NAME: * JOB #: COORDINATOR NAME: * COORDINATOR EMAIL: * COORDINATOR PHONE NUMBER: * CREDIT CARD INFORMATION CREDIT CARD HOLDER * CARD ACCOUNT NUMBER * EXPIRATION DATE * VERIFICATION CODE * CREDIT CARD BANK NAME * CUSTOMER SERVICE PHONE NUMBER * CREDIT CARD BILLING ADDRESS * PHONE NUMBER * RELEASE TO THE NAME OF: Upload a picture of the front and back of your Credit Card and Driver’s License * Drop a file here or click to upload – Upload a picture of the front and back of your Credit Card and Driver's License Choose File Maximum file size: 30MB A 2% processing fee will be applied. If you choose to use your credit card for the deposit to secure rentals please be advised that this will be put through as a charge authorization hold. It generally takes 10 days before the bank releases the hold on the funds. If this is an inconvenience please ask your salesperson for other options. Additional billing and any loss or damage will be charged directly to your credit card. I AUTHORIZE SET STUFF INC. TO CHARGE MY CREDIT CARD. IF ALL THE INFORMATION ABOVE IS CORRECT AND YOU AGREE, PLEASE CLICK THE SUBMIT BUTTON BELOW. Print Name * Signature * signature keyboard Clear reCAPTCHA Submit Start Over If you are human, leave this field blank.
