Credit Card Authorization Form Cardholder
Information Name of Company Job
_____________________________________________________________________________________________
Name of Cardholder
_____________________________________________________________________________________________
Credit Card Number
_____________________________________________________________________________________________
Expiration Date
______________________________3-4 digit code__________________________________________________
Billing Address
_____________________________________________________________________________________________
City, State, Zip
_____________________________________________________________________________________________
Home Phone_________________________________________________________________________________
Business_____________________________________________________________________________________
Drivers License
#_____________________________State_______________ Federal Tax ID#_________________________________
Please include copies of the following items: Cardholder’s driver’s license, Credit card (front and back), and Certificate of Insurance Cardholder’s Signature (Must match DL) I authorize Oceans 11 RV rental/ LA Discount RV rental to charge my credit card for the rental. The undersigned agrees that all monies due to Oceans 11 RV rental under the aforementioned rental agreement may be charged to the credit card identified above. The charges herein shall include, but shall not be limited to, daily rental charges, drop off charges, loss damage waiver (LDW) and/or liability waiver (LIW) charges, and any charges for loss or damage to the vehicle. The authorization shall apply to all charges incurred during the term of the rental agreement and any extensions thereof. Pursuant to their standard rental agreement, the terms of which are hereby acknowledged, to charge all sums under their credit card account and to do all acts necessary to process the credit card charge for payment. The undersigned specifically authorizes Oceans 11 RV rental to extend the rental agreement if needed. In the event that the credit card company described above fails or refuses to make payment for the charges submitted, the undersigned individual agree that he/she will be unconditionally responsible and liable for any and all charges personally.
Date_____________________
Signature_______________________________