El Camino Rental Credit Card Authorization Form


El Camino Rental

CREDIT CARD AUTHORIZATION FORM

*Master Card, Vista, Discover, American Express*
 
CUSTOMER NAME
 
DRIVERS LICENSE NUMBER
 
EXPIRATION DATE
 
 
CELL PHONE NUMBER
 
DATE OF BIRTH
 
 
 
Name As It Appears On Credit Card
 
Email
 
Billing Area Code And Phone Number
This agreement unconditionally authorizes, El Camino Rental, to charge the following credit card:
 
 
 
CC Number
 
Billing Address (Street, City, Zip)
 
 
Credit Card Type
 
CC Expiration Date
 
 
CVN 3 Digit Back Of Card (Amex, 4 front)
 
State
 
 
 
Job Address (Street, City, State, Zip)
I certify that the above statements and information made in the agreement are true and correct.
 
 
 
Authorized card Holder Signature
 
Date
 
Requested By
Please fax form to prospective location listed below:
Location
 
 
 
 
 
 
 
 
Picture of Credit Card to be used
 
 
Picture of Drivers License or State I.D.