CREDIT CARD AUTHORIZATION

Recurring Payment Authorization Form

Here’s how Recurring Payments Work: You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated below each billing period. A receipt for each payment will be emailed to you. ____________________________________________________________

Please complete the information below:

I authorize Van With A Man to charge my credit card indicated below for the amount of $ on the of each month beginning for payment of my storage.

Billing Address

Phone # Email

Visa Mastercard Amex Discover

Account #

Three Digit Code (on back) Amex: Four Digit Code (on front)

Expiration Date

Zip Code Associated With The Credit Card