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_______________________________