CREDIT CARD PURCHASE AUTHORIZATION FORM Once you have completed this credit card authorization form., please email the signed copy back to Mosaic Event and Party Rentals. Your reservation cannot be completed until this signed document is on the file. This process helps to ensure that all our clients are fully informed and fully protected. We thank you for your co-operation.
Credit Card Information
Card # _________________________________________________
Expiry Date __________________________
CVV ___________________
Credit Card Billing Address _________________________________________________
City, Province ________________ Postal Code ________________
Telephone ________________________________________
Authorization Agreement: By signing this letter of agreement I,___________________________(full name as it appears on your credit card) hereby give my fully-informed consent, and I agree to allow Mosaic Event and Party Rentals to debit my _____________(Visa or Mastercard) for the amount of $ _____________________(invoice, deposit/balance/damage s or loss of rentals) Also, by signing this credit card purchase authorization form, I hereby give my complete approval to debit the same credit card indicated above for all damages or loss of rentals which I/my representative have directly ordered and authorized through Mosaic Event and Party rentals. Signed __________________________
(Signature of Credit Card Holder)
Date ________________________________