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MONTHLY CREDIT CARD PAYMENT AUTHORIZATION FORM Credit Card Type

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					                             MONTHLY CREDIT CARD PAYMENT
                                 AUTHORIZATION FORM




Unit #(s): _______

Name on Rental Agreement: _______________________________________________________

Terms of Agreement: I hereby authorize Park Place Investments, LLC to charge my monthly rental
fees to my credit card indicated below. No payment to Park Place Investments, LLC shall be
deemed to have been made unless and until Park Place Investments, LLC receives actual credit,
and may be subject to additional fees and or late charges if credit is denied at time of processing. I
also understand that if corrections of the entry are necessary, it may involve an adjustment to my
account. Furthermore, I understand that my credit card payment of the amount due will be
charged to my credit card on or after the due date indicated on the unit(s) rental agreement(s).

Note: Park Place Investments, LLC reserves the right to refuse or terminate automatic credit card
payment services. This agreement will remain in effect until terminated by Park Place
Investments, LLC or until a written notification of its termination is received from the account holder
with sufficient time to act on said request.


Credit Card Type (Circle One):


Name As It Appears On The Card:___________________________________________

Card Number:_____________________________________ Expiration Date: _________

AVS Code __ __ __ (this number is required in order for us to process your card
payment and can be found on the back of your card, shown as the last 3 digits on
the signature strip)


________________________________________________                       ________________
Signature of Cardholder                                                         Date




                                       P O Box 67
                                     Milton WI 53563
                           Phone 608-868-7379 Fax 608-868-4925

				
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