Credit Card Authorization


If you are authorizing for a first time rental, please return this form via email, along with a legible copy of both your credit card and your driver’s license.

 

Today's Date: October 24, 2020

Company:

Contact:

 

I hereby authorize Gilded Cinema, LLC to charge my credit card for any charges should the equipment rental period extend, or if there is loss or damage to the equipment. 

 

I hereby authorize a charge of up to $2,500 for the Insurance Deductible. I understand Gilded Cinema, LLC is authorized to deduct this amount should there be any loss or damage. Gilded Cinema, LLC is authorized to deduct from this amount should there be any loss or damage to the equipment.

 

Please check one of the following: 

 

Card #:  

Exp Date:  

 

The CVV2 Number/Signature Panel Code:  

(the 3 digit number after the card # on the back of the card) 

 

Name: (as it appears on the card) 

Billing Address: 

  

 

Future Rentals: To use this form as an authorization for all future rentals, please fill in the requested information below and initial where requested. This help us process your future orders faster. 

 

I hereby authorize Gilded Cinema, LLC to put charges for future rentals on my credit card. 

 

Card #:  

Exp Date:  

 

Up to a limit of $ per rental. 

 

This authorization is valid for one year from today's date: October 24, 2020

 

Leave this empty:

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Signature Certificate
Document name: Credit Card Authorization
lock iconUnique Document ID: 8ecfdfb8342d90bf520c119d3a1ba236d4599746
Timestamp Audit
September 12, 2019 3:52 pm PDTCredit Card Authorization Uploaded by Alex Darke - [email protected] IP 74.126.231.33