Credit Card Authorization – Whitewright Rentals

Authorize Form

Credit Card Authorization Form

By signing this form, you authorize Vanguard Rentals (a division of Vanguard Management, LLC) to charge the credit card listed below for the amount indicated, for the approved rental period. This authorization applies only to the specific transaction listed and does not permit additional or future charges without written consent.

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone

Payment Details

Amount Authorized

Description of Rental / Equipment

Credit Card Details

Account Type

Visa

MasterCard

AMEX

Card Number

Expiration Date (MM/YY)

CVV

Authorization

I certify that I am an authorized user of this credit card and agree not to dispute the payment so long as the transaction corresponds to the terms of this authorization form. I confirm that the rental equipment has been received in satisfactory condition unless noted otherwise.

Cardholder Signature

Date

Printed Name