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Rental Authorization Payment Form For 3rd Party P.U. or Delivery

Secure Credit Card Authorization Form

Card Member Billing Info

Please note: This form is valid for US residents only, others must pay in person.
Credit card billing info is different than the renter

Company name is Required for Company Cards

Adress must match CC statement address - No P.O.B. - Only US address

Transaction details

Payment details

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Our verification dept. reserves the rights to contact you to request copies of the front and back of your card for additional security

Security deposit or Insuarance is required for rentals with item values of above $5000.00

Security Deposit is for the Rental value of the Rented Items, Replacement Value is listed at the bottom of your rental order. Security Deposit will be refunded at return of your rental

Copy of Credit Card bill, bank statement, or Utility bill. Required if address on Drivers license doesn't match card billing address.

Third Party Autorization

I authorize to rent at CSI Rentals on my credit card account on  /  / .

Agreement

Signature

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