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Security Deposit Auth Form

Payment Processing permission to charge my American Express: (*)
Please choose you card

In The Amount Of $ (*)
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Card number(*)
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Card CVV(*)
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Expiration Date:(*)
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Name As It Appears On Card(*)
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Address
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City
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State
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Province
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Zip Code (and Country, if not U.S.)
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Email Address(*)
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BY SIGNING THIS YOU UNDERSTAND THAT THIS AMOUNT WILL BE CHARGED ON YOUR CREDIT CARD 1 WEEK PRIOR TO RENTAL DATES, AND THAT THE AMOUNT WILL BE REFUNDED IF NO DAMAGES ARE INCURRED.
Signature
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Date
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Weather

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