THIS DOCUMENT AUTHORIZES THE USE OF THE CREDIT CARD LISTED BELOW
Company Name: ______________________________________________________________
Name of Cardholder as
It appears on the card: _________________________________________________________
Billing Address, City, Zip Code, Sate
Billing Address: ______________________________________________________________
Billing City_________________ Billing Zip Code________________________State: ______
Card Type: (Circle One) Master Card, Visa, Discover, American Express
Credit Card #_______________________________________
Expiration Date: _____________________________
CVV CODE: (BACK OF CARD)_______________
CVV Code Amex only (front of card)_____________
Signature: __________________________________________
Date: ________________________
Phone Number: _______________________ Fax Number: ________________________
E-Mail Address:________________________
Please fax back to us at: Corporate Fax Numer at 561-739-9977
By providing this card as deposit you hereby authorize ABC Rentals, Inc. to place
any remaining unpaid balance on this card should you fail to pay for your rental.
