Credit Card Authorization

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GENERAL INFORMATION
AUTHORIZED USER OF CREDIT CARD

Name on Card

Company Name

Credit Card Type*

Visa

Master Card

Discover

American Express

Other

Write here

Credit Card Number

Expiration Date

Security Code

Billing Address

City

State

Zip

Phone

Fax

Name

Company Name

Relationship to Owner

Drivers License Number

Phone

Fax

Authorized Amount

Type of Charges

Date of Charges ×

Authorization*

I certify that I am the authorized holder and signer of the credit card referenced above. I certify that all information above is complete and accurate. I hereby authorize collection of payment for all charges as indicated above. Charges may not exceed the amount listed above in the “AUTHORIZED AMOUNT” field. I understand this is only for up to this amount during the time period of “DATES OF CHARGES” referenced above. If additional charges are going to be authorized a new form will have to be completed.

I agree

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CONTACT US

Reach out to us through any of the following forms or feel free to stop by the studio.

LOCATION

2018 S. 1st Street
Suite 220
Milwaukee, WI 53207

HOURS

Mon – Fri …… 9 am – 5:30 pm
Sat, Sun …… Closed

PHONE

414.765.1111

EMAIL

rentals@nacamera.com