Scribd
Upload
63 views1 page

Fax Back

This document provides instructions for completing an agreement to verify a credit/debit card or apply for a limit increase. It states that the customer should enter their account information, make an imprint of their embossed card, sign and date the agreement, and fax it along with a photocopy of their ID, front and back of their card enlarged to 120%, and a copy of a recent utility bill. It also includes text for an authorization agreement acknowledging the customer is the authorized cardholder and certifying the information provided is accurate.

Uploaded by

Alifrmcali Norwalk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
63 views1 page

Fax Back

This document provides instructions for completing an agreement to verify a credit/debit card or apply for a limit increase. It states that the customer should enter their account information, make an imprint of their embossed card, sign and date the agreement, and fax it along with a photocopy of their ID, front and back of their card enlarged to 120%, and a copy of a recent utility bill. It also includes text for an authorization agreement acknowledging the customer is the authorized cardholder and certifying the information provided is accurate.

Uploaded by

Alifrmcali Norwalk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

To verify a credit/debit card or apply for a limit increase, please complete the agreement below:

For each credit/debit card used, enter the account information below and print the agreement.
In the space provided at the bottom of the form, make an imprint of your credit/debit card by
placing the card under the printed form and very lightly rubbing a pencil over the top. Applies
to embossed cards only.
Sign and date the bottom of the agreement.
Fax the completed agreement with:
o A legible photocopy of your picture ID (e.g. Drivers License or Passport)
o Photocopies of the front and back of your credit/debit card. Enlarge to 120% for best
results.
o A copy of a recent utility bill of official mail that contains your name and address as
registered on your player account.
Authorization Agreement & Account Verification
By submitting this signed and dated form, along with the additional information requested, I am authorizing and
fully acknowledging the following:
I am the authorized cardholder and will honor all purchases initiated by me to my account whether
completed by telephone or internet,
I certify that the information provided and supporting documentation is truthful and accurate,
I am of age of majority (18 years or older, depending on your jurisdiction)
I have read and accepted the terms of use as listed elsewhere on this website
Please enter your information below:

Customer Account ID:

Full Name:
Address, State, Country, ZIP:

Phone:

E-mail:
Card No. and Exp. Date: Mo.: Yr.:

Issuing Bank Name:

Issuing Bank Phone: *Toll free # on back of card.


I hereby understand and authorize the above as evidenced by my signature below.
Signature: _______________________________________ Date: _________________________
To make an imprint of your embossed card:
1. Place card under box outline,
2. Rub pencil very lightly over card,
3. Ensure your name, number & expiration date are clear and readable.

Thank you for reading and


complying with our terms and
conditions.

You might also like