RECEIVED BY ACCOUNT MANAGER POSTED BY DATE. HST REGISTRATION #: 8197-08926-RP0001. Page 1 of 1. Credit Card Authorizatio
Credit Card Authorization Authorization
CUSTOMER NAME (“THE CUSTOMER”)
OPERATING AS (IF APPLICABLE)
I ____________________________________________ hereby authorize Abso Rental Services to charge the following credit card (the “Credit Card”) to transact deposits, pre-authorization and/or charges related to services and/or products supplied or to be supplied to Customer. I understand that any payment will not be made unless written permission is given prior the transaction. I will be present to sign transaction slips. However, if I am unable to attend in person, then the signature confirming a Rental Reservation is to be taken as my irrevocable acceptance of the charge against my Credit Card, equal to the amount shown on the relevant Rental Reservation Agreement / invoice(s). Credit Card Information: Please Complete All Fields
CARDHOLDER’S NAME (AS IT APPEARS ON CARD)
CARD TYPE
CARD NUMBER
EXPIRY DATE (MM/YY)
ADDRESS OF CARDHOLDER
CITY
PROVINCE
POSTAL CODE
EMAIL
TELEPHONE
FAX
SIGNATURE
DATE
Option To Keep Credit Card On File Initial to decline keeping your Credit Card Authorization on file. If declined, a new Credit Card Authorization Form must be filed with each new order. DECLINE
Acknowledgement
1. It is hereby agreed and understood that information contained herein shall only be used for charges, deposits, and/or pre-authorizations related to the services and/or products supplied or to be supplied. Further, this information will not be shared, distributed, or otherwise used for any purpose other than the described without my express written permission. 2. I acknowledge that Abso Rental has my authorization to charge the Credit Card for further orders that may be placed with Abso Rental on behalf of the Customer. 3. I acknowledge my acceptance of additional charges that may be debited to the Credit Card for late return charges, damages, and/or loss of equipment supplied to Customer. 4. I understand that the Security Deposit charged to the Credit Card is fully refundable if the rental equipment is returned on time and in good condition, as defined in the Master Rental Agreement. 5. By signing above, I agree to be bound by the Terms and Conditions contained in the ABSO Rental Agreement and agree to pay any and all costs associated with the services and/or products, having personally read and understood said Terms and Conditions.
FOR OFFICE USE ONLY – Client ID #
RECEIVED BY
ACCOUNT MANAGER
POSTED BY
DATE
HST REGISTRATION #: 8197-08926-RP0001
ABSO RENTAL SERVICES 22 Jutland Road, Unit C, Toronto, ON Canada M8Z 2G9
416-255-FILM (3456) tel 416-255-5852 fax www.absorental.com /
[email protected] 