Loring Parking Ramp – CREDIT CARD AUTHORI AUTHORIZAT ZATION ION Name: ________________Account Number: _____________ _________ ____ Email:_______________ Billing Bill ing Address: Address:________ ________________ ________ City:_______ City:_________Stat __State:____ e:____ Zip:________ Zip:_______________ _______ Business Address:_______________ City:_________State:____ Zip:_______________ Zip:_____________ __ Home Phone:____________ Business Phone: ____________Fa: __________________ Vehicle Make:
Vehicle License:
Driver’s Lic. No.:
Parking to commence: January 01, 01! " here#y authori$e %llie& %llie& Parking, "nc. to charge my cre cre&it &it car& on a monthly #asis 'or (arking charges incurre& incurre& each month. )re&it car&s car&s *ill #e charge& charge& #et*een the 'irst an& the 'i'th o' each month. Credit Card Visa
M/Card
AMEX
/
Expiration Date
Discover
on bac# o$ card
!ast " digits
Card Number
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Amex Number
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Valid Va lid Date Signature/ Authoriation
Date
%t is the customer&s responsibility to cancel the authori'ation (ith their credit card company upon proper noti$ication to to Al Allied lied Par#ing) %nc* o$ their termination termination o$ par#ing* %$ the customer $ails to do so) the liability o$ Allied Par#ing) %nc* is limited to a maimum re$und o$ t(o +,- months& par#ing payments* All re!ected transactions carr" a #$%&'' administrative (ee&
.his agreement is sub/ect to the Par#ing Agreement +!ease- $or the Centre 0illage 1amp*
I ACCEPT AND AGREE TO THIS MONTHLY PARKING PARKING AGREEMENT WITH Allied Parking, Inc.. I ACKNOWLEDGE THAT I HAE THAT HAE READ AND AGREE TO TH THE E TERMS AND CONDITIONS LISTED A A!OE, !OE, AS WELL AS THE MONTHLY PARKING AGREEMENT "LEASE# $OR THE CENTRE ILLAGE RAMP.