Credit Card Authorization Form

Please provide all the information requested below to ensure the prompt processing of your rental order. You can also download a copy of the form if you prefer.

Account Type(*)

Individual Business 3rd Party Master Invalid Input

First_Name(*)

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Date of Event(*)

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Last Name(*)

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Location of Event(*)

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Cardholder Information

Name (as it appears on the credit card): (*)

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Card type(*)

Visa MasterCard American Express Invalid Input

Account Number(*)

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Expiration Month(*)

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V Code (last 3 digits on the back) OR CID (4 digits on the front)(*)

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Expiration Year(*)

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Card Holder’s Billing Address

Street Address(*)

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City(*)

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State(*)

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Zip Code(*)

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Phone(*)

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Fax

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By checking the "Agree" box below and signing in the space provide, I acknowledge:

1) This form constitutes a binding agreement for full payment for the above-specified charges which are detailed on your contract. As well, any damages incurred to rental equipment.
2) APR does not require deposits for your rental order. Returning this form will transfer your quote (inventory is not reserved on a quote) to a rental reservation.

Acknowledgement(*)

Yes Invalid Input

Signature(*)

Sign Above

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