Security Deposit Form printable pdf download

Security Deposit Form

Credit Card Consent / Security Deposit Form

PSAV LOCATION NUMBER: _3698___ Property Name: __Hyatt Regency New Orleans________

Credit Card Type: American Express______ Discover______ MasterCard______ Visa______

Credit Card Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Expiration Date: ______________________________________________________________

Cardholder’s Name: ___________________________________________________________

(As it appears on credit card)

Cardholder Billing Address: _________________________ Zip Code (REQUIRED): _________

(Only numeric portion required)

Cardholder email address: ______________________________________________________

Cardholder’s Phone Number:____________________________________________________

Customer Name: ______________________________________________________________

(Name as it should appear on the invoice)

Invoice/Order Number(s): ___________________________ Customer PO: ______________

(If a PO # is not provided use loc # and Order ID XXXX XXXX)

I, (please print) ______________________________________________, certify the above information to be true and

correct to the best of my knowledge. As the cardholder, I am authorizing the above credit card account to be charged

for the attached order and any additional amounts incurred as a result of all show site changes ordered by my

representatives and/or place my card on file for Security Deposit purposes in the event of payment default,

cancellation fees or damages/losses owed per PSAV Terms and Conditions – See Terms and Conditions.

Signature____________________________________________Date______________________________

Security Deposit Form