CREDIT CARD AUTHORIZATION FORM - Online … CARD AUTHORIZATION FORM Email this form along with high...

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CREDIT CARD AUTHORIZATION FORM Email this form along with high resolution copies of the following to: [email protected] 1) Color copy of Passport or Driver license of Accountholder (both sides). 2) Color copy of Passport or Driver License of the card holder of each Authorized Credit Card. 3) Color copy of Authorized Credit Card(s) (both sides). 4) Color copy of a Utility Bill, bank statement or credit card statement, not older than two (2) months User Name or Customer Number (Logon) Date Account holder Name Contact Phone 1 Account holder Street Address, Unit/Suite/Apt Number, City, State, ZIP Contact Phone 2 By placing my signature below, I authorize the use of the following credit card(s) (“Authorized Cards”) for depositing into the above-mentioned Springbok Casino account. I confirm that I have been authorized to use each of the Authorized Cards listed below and acknowledge that I must pay all charges incurred by these cards through transactions to my Springbok Casino account, regardless of when or by whom the transaction was authorized. I confirm that you shall be fully protected when honoring any payments from my Authorized Cards. In addition, should any payment from an Authorized Card for whatever reason whatsoever not be honored, I confirm that you shall be under no liability for any costs, including bank fees, even though this may mean that my Springbok Casino account may become inaccessible. By: Signed Dated Print Name Credit Card (1) Credit Card Number Expiry Date: Card Type Card billing address: Name as shown on card Signature of card holder today's date Credit Card (2) Credit Card Number Expiry Date: Card Type Card billing address: Name as shown on card Signature of card holder today's date VISA MASTERCARD DINERS CLUB AMEX VISA MASTERCARD DINERS CLUB AMEX

Transcript of CREDIT CARD AUTHORIZATION FORM - Online … CARD AUTHORIZATION FORM Email this form along with high...

Page 1: CREDIT CARD AUTHORIZATION FORM - Online … CARD AUTHORIZATION FORM Email this form along with high resolution copies of the following to: documents@springbokcasino.co.za 1) Color

CREDIT CARD AUTHORIZATION FORM Email this form along with high resolution copies of the following to: [email protected] 1) Color copy of Passport or Driver license of Accountholder (both sides). 2) Color copy of Passport or Driver License of the card holder of each Authorized Credit Card. 3) Color copy of Authorized Credit Card(s) (both sides). 4) Color copy of a Utility Bill, bank statement or credit card statement, not older than two (2) months

User Name or Customer Number (Logon) Date

Account holder Name Contact Phone 1

Account holder Street Address, Unit/Suite/Apt Number, City, State, ZIP Contact Phone 2

By placing my signature below, I authorize the use of the following credit card(s) (“Authorized Cards”) for depositing into the above-mentioned Springbok Casino account. I confirm that I have been authorized to use each of the Authorized Cards listed below and acknowledge that I must pay all charges incurred by these cards through transactions to my Springbok Casino account, regardless of when or by whom the transaction was authorized. I confirm that you shall be fully protected when honoring any payments from my Authorized Cards. In addition, should any payment from an Authorized Card for whatever reason whatsoever not be honored, I confirm that you shall be under no liability for any costs, including bank fees, even though this may mean that my Springbok Casino account may become inaccessible.

By: Signed Dated

Print Name

Credit Card (1) Credit Card Number Expiry Date:

Card Type

Card billing address:

Name as shown on card

Signature of card holder today's date

Credit Card (2) Credit Card Number Expiry Date:

Card Type

Card billing address:

Name as shown on card

Signature of card holder today's date

VISA MASTERCARD

DINERS CLUB AMEX

VISA MASTERCARD

DINERS CLUB AMEX

CLAIM AND AUTHORIZATION FORM · RBC Insurance Company of Canada authorization to obtain, recover and forward information, payments and/or obtain recovery from your Credit Card, Extended

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PAYMENT & CREDIT CARD AUTHORIZATION FORM - …acinwaterboatshow.com/2017 VISTA SERVICES.pdf · 2017-07-26 · Orders received without full payment or credit card information will

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CREDIT CARD AUTHORIZATION FORM - Hyatt · CREDIT CARD AUTHORIZATION FORM. Individual/Business/Group or Event Name: Reservation Confirmation Number: Arrival or ... Card Billing Address:

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State - grpa.org · CREDIT CARD AUTHORIZATION Name on Credit Card: _____ Credit Card Billing Address

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credit card authorization - Century Car Service · Seattle Prestige TownCar Service 425-346-6232 Credit Card Authorization Form I,_____ authorize Century Car Service to process all

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Credit Card Authorization Form - FT-CS (CCA)-2019-06 · Title: Microsoft Word - Credit Card Authorization Form - FT-CS (CCA)-2019-06 Author: asad.siddiqui Created Date: 7/9/2019 12:27:49

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One-Time Credit Card Payment Authorization Form€¦ ·  · 2017-10-24One-Time Credit Card Payment Authorization Form. Please sign and complete this form to authorize Medversant

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CC AUTHORIZATION FORM

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CREDIT CARD AUTHORIZATION FORM JUICYSTAKES · CREDIT CARD AUTHORIZATION FORM JUICYSTAKES Email this Form along with copies of the following to documents@juicystakes.eu 1) Color copy

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By: Signed Dated Print Name Authorized Card (1) CARD NUMBER: … · 2019-07-30 · CREDIT CARD AUTHORIZATION FORM SLOTO CASH CASINO Email this Form along with copies of the following

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Credit Card Authorization Electronic Credit Card ...€¦ · 3 WHAT IS ELECTRONIC CREDIT CARD AUTHORIZATION? (eCCA) Electronic Credit Card Authorization is a secure process built

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Credit Card Authorization Form - Edmonds Community College · Credit Card Authorization Form Name of Student(s): Student(s) ID No.: Person’s Name on the card: Billing Address: I

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By: Signed Dated Print Name Authorized Card (1) CARD NUMBER: EXPIRATION DATE: CARD ... ·  · 2017-04-10CREDIT CARD AUTHORIZATION FORM Email this Form along with copies of the following

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Direct Deposit Authorization Form - Spokane Transit Authority · Direct Deposit Authorization Form ☐ New Authorization ☐ Change Account(s) ☐ Cancel Authorization Employee Name:

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