I ____________________________________ Authorize “Chaotic Boat Rentals, LLC”. To charge my Credit Card#________________________________,
Expiration Date ____/____, Code#_______ (3 Digit # on Reverse Side of Credit Card)
Name as it appears on card_______________________________________________.
The charges will be for Rental,
Security Deposit, and any Damages that may occur to rented equipment/vessel. Any missing, lost, stolen items not returned
at completion of Rental Agreement will be charged after 24 Hours, if not replaced.
Rental Name_________________________________________
Rental Dates_________________________________________
I agree to Authorize “Chaotic
Boat rentals, LLC.” To charge my Credit Card for ANY and ALL charges incurred by and during the Rental Agreement.
Print Name __________________________________
Signature ____________________________________
Today’s Date ___________________
Time _________
Place Drivers License Here
Place Credit Card Here
***** Please Photocopy Drivers License and Credit Card*****
In above area, make sure it is clear and readable.
This will be used to satisfy the Merchant Processing Agreement Requirements and to STOP FRAUD.
********THIS FORM IS REQUIRED WHEN CARD/CARD HOLDER IS NOT PRESENT******
