Ramada Credit Card Authorization Form

Published on April 2017 | Categories: Documents | Downloads: 39 | Comments: 0 | Views: 408
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 Ramada Parking Lot – CREDIT CARD AUTHORIZAT AUTHORIZATION  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

-

Amex Number

-

-

-

/

Valid Va lid Date Signature/ Authoriation

 

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 maimum 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 HAE  THAT HAE READ AND AGREE TO TH THE E TERMS AND CONDITIONS LISTED A A!OE, !OE, AS WELL AS THE MONTHLY PARKING AGREEMENT "LEASE# $OR THE CENTRE ILLAGE RAMP.

SIGNAT%RE& A%THORI'ATION())))))))))))))))))))))

DA DATE( TE( ))))))))))))))) 

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