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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.

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Alifrmcali Norwalk
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50 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
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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.

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