Credit Card Authorization - Discount RV & Shops - 15820 County Rd 2100
Please fill in the following information so we can prepare your self storage rental agreement.
Unit # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Credit Card Information
This form is secure. Credit Card numbers will remain hidden for your protection until we authorize payment.
Name On The Card {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Credit Card Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue, convert=Cognito.maskText }
Expiration Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
CVV2 # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
I authorize Discount Self Storage to withdraw payment from the above noted account. If payment on unit is not made prior to the agreed upon due date, Tenant authorizes Discount Self Storage to apply the total amount due to the above mentioned credit card on or after the said due date. Tenant also authorizes Discount Self Storage to use any credit/debit card I update at a future date.
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}