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  • CC Auth Form

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    Ben chasteen
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    Fotocare Ltd. requests credit card authorization from a customer to satisfy rental security deposits or payments. The customer provides their credit card number, expiration date, CVV code, billing address and phone number. Optionally, the customer can authorize a specific person to use the credit card for a defined time period by providing that person's name, signature and driver's license information. The completed form should be faxed back to Fotocare Ltd.

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    Fotocare document

    Original Title

    Cc Auth Form

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    Fotocare Ltd. requests credit card authorization from a customer to satisfy rental security deposits or payments. The customer provides their credit card number, expiration date, CVV code, billing address and phone number. Optionally, the customer can authorize a specific person to use the credit card for a defined time period by providing that person's name, signature and driver's license information. The completed form should be faxed back to Fotocare Ltd.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    15 views1 page

    CC Auth Form

    Uploaded by

    Ben chasteen
    Fotocare Ltd. requests credit card authorization from a customer to satisfy rental security deposits or payments. The customer provides their credit card number, expiration date, CVV code, billing address and phone number. Optionally, the customer can authorize a specific person to use the credit card for a defined time period by providing that person's name, signature and driver's license information. The completed form should be faxed back to Fotocare Ltd.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Fotocare Ltd.

    43 West 22nd St.


    New York, NY 10010
    212-741-2991
    646-336-5549 Fax

    CREDIT CARD AUTHORIZATION


    Date________________ I, _________________________, hereby authorize Fotocare Ltd.
    to utilize the below referenced credit card to satisfy rental security and/or payment for rental
    or sale. (ALL INFORMATION REQUIRED!)

    Card #_______________________________________Expiration Date______________

    V-Code #__________________ CID #_______________________


    (Visa/Mastercard-last 3 #’s on signature strip) (AMEX -- 4 digit # on front above card
    number)

    Exact Cardholder Name____________________________________________________

    Cardholder Signature______________________________________________________

    Exact Card Billing Address/Zip ______________________________________________

    ______________________________________________

    Phone number at the card billing address ______________________________________

    NOTE! If you wish to limit the use of the above authorization to a specific person or to
    an expected time period, please complete the following:

    The person stated below is hereby authorized to bind, with his/her signature, the above
    referenced credit card on behalf of the cardholder in order to satisfy payment and/or rental
    security to Fotocare Ltd. for the expected time period _____________________________.

    Print name of authorized person who will be present at time of pickup to sign for credit card
    purchase on your behalf: ___________________________________________________

    Signature of person you authorize:____________________________________________

    Their Driver’s License # ___________________________________ DL State_________


    (ID will be required at pickup)

    After completing this document, please forward via FAX to Fotocare.


    Thank you!

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