Beach Retreat Vacation Rental
Miller Assets, LLC c/o Mark and Deborah Miller 301 Creekside Drive League City, Texas 77573 Office: 866-303-6442, 832-632-4568 Cellular: 409-682-0185 Fax 713-893-6189 CREDIT CARD AUTHORIZATION FORM Once you have completed this credit card authorization form, please fax or mail the signed copies back to Mark Miller. Your reservation cannot be completed until this signed document is on file. This credit card policy aims to protect you, our valued client, from costly cancellation penalties & from any fraudulent use of your card by persons other than the bona fide cardholder. This process helps us ensure that all our clients are fully informed & fully protected. We thank you very much for your co-operation & good will. PLEASE VERIFY YOUR CARD NUMBER: Along with this signed agreement, please also fax/mail us a PHOTOCOPY, FRONT AND BACK of your CREDIT CARD, with the card bearer's name & the number showing clearly. By signing this letter of agreement, & by photocopying my credit card
I, ________________________________________ (print full name as it appears on your credit card.) hereby give my fully-informed consent, & I agree to allow Mark Miller of Miller Assets, LLC
to debit my__________________________________________________ (credit card company name)
credit card number __________________________________ expiry date __________________
By this credit card document I hereby give my complete approval to pay in full for all specific services which I have directly ordered & authorized to be booked by Mark Miller of Miller Assets, LLC for the vacation rental. I further agree to abide by all of Beach Retreat’s cancellation and change policies, as expressed in the Terms & Conditions of sale as discussed at time of booking. Beach Retreat utilizes Pay Pal for credit card transactions. CLIENT APPROVES PAYMENT FOR THESE SPECIFIC SERVICES: Vacation Rental YES NO
Signed: ____________________________________ Dated: ________________ (Signature of credit card holder)