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CREDIT CARD AUTHORIZATION FORM UPTOWN ACES Email this Form along with copies of the following to [email protected] 1) Color copy of Passport or Driver license of Accountholder (both sides). 2) Color copy of valid Passport or Driver license of the card holder of each authorized credit card 3) Color copy of Authorized Credit Card(s) (both sides). 4) Color copy of a Utility Bill, bank statement or credit card statement, not older than two (2) months User Name or Customer Number Date Accountholder Name Accountholder Contact Telephone #1 Accountholder Street Address, Unit/Suite/Apt Number, City, State, ZIP Accountholder Contact Telephone #2 By signing below, I authorize the use of the following credit cards ("Authorized Card(s)" for loading my Uptown Aces account identified above. I also agree that I have been authorized to use all of the Authorized Card(s) listed below and agree to pay any and all charges incurred by these cards to fund my Uptown Aces account, regardless of when or by whom the transaction was authorized. I agree that you shall be fully protected in honoring any such Authorized Card(s) payments. I further agree that if any such Authorized Card(s) payment be dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability whatsoever, including any fees imposed by my bank, even though such dishonor may result in the inaccessibility of my Uptown Aces account. By: Signed Dated Print Name Authorized Card (1) CARD NUMBER: EXPIRATION DATE: CARD TYPE CARD BILLING ADDRESS: (if different than above) CARDHOLDER'S NAME (as it appears on the credit card) SIGNATURE OF CARDHOLDER TODAY'S DATE Authorized Card (2) CARD NUMBER: EXPIRATION DATE: CARD TYPE CARD BILLING ADDRESS: (if different than above) CARDHOLDER'S NAME (as it appears on the credit card) SIGNATURE OF CARDHOLDER TODAY'S DATE Authorized Card (3) CARD NUMBER: EXPIRATION DATE: CARD TYPE CARD BILLING ADDRESS: (if different than above) CARDHOLDER'S NAME (as it appears on the credit card) SIGNATURE OF CARDHOLDER TODAY'S DATE Authorized Card (4) CARD NUMBER: EXPIRATION DATE: CARD TYPE CARD BILLING ADDRESS: (if different than above) CARDHOLDER'S NAME (as it appears on the credit card) SIGNATURE OF CARDHOLDER TODAY'S DATE Question? E-mail [email protected] [email protected] VISA MASTERCARD AMEX VISA MASTERCARD AMEX VISA MASTERCARD AMEX VISA MASTERCARD AMEX

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  • CREDIT CARD AUTHORIZATION FORM UPTOWN ACES Email this Form along with copies of the following to [email protected] 1) Color copy of Passport or Driver license of Accountholder (both sides). 2) Color copy of valid Passport or Driver license of the card holder of each authorized credit card 3) Color copy of Authorized Credit Card(s) (both sides). 4) Color copy of a Utility Bill, bank statement or credit card statement, not older than two (2) months

    User Name or Customer Number Date

    Accountholder Name Accountholder Contact Telephone #1

    Accountholder Street Address, Unit/Suite/Apt Number, City, State, ZIP Accountholder Contact Telephone #2

    By signing below, I authorize the use of the following credit cards ("Authorized Card(s)" for loading my Uptown Aces account identified above. I also agree that I have been authorized to use all of the Authorized Card(s) listed below and agree to pay any and all charges incurred by these cards to fund my Uptown Aces account, regardless of when or by whom the transaction was authorized. I agree that you shall be fully protected in honoring any such Authorized Card(s) payments. I further agree that if any such Authorized Card(s) payment be dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability whatsoever, including any fees imposed by my bank, even though such dishonor may result in the inaccessibility of my Uptown Aces account.

    By: Signed Dated

    Print Name Authorized Card (1)

    CARD NUMBER: EXPIRATION DATE: CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER TODAY'S DATE

    Authorized Card (2) CARD NUMBER: EXPIRATION DATE: CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER TODAY'S DATE

    Authorized Card (3) CARD NUMBER: EXPIRATION DATE: CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER TODAY'S DATE

    Authorized Card (4) CARD NUMBER: EXPIRATION DATE: CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER TODAY'S DATE

    Question? E-mail [email protected]

    [email protected]

    VISA MASTERCARD

    AMEX

    VISA MASTERCARD

    AMEX

    VISA MASTERCARD

    AMEX

    VISA MASTERCARD

    AMEX

    D:20061204131748Z

    D:20070327135609+02'00'

    CREDIT CARD AUTHORIZATION FORM UPTOWN ACES

     

    Email this Form along with copies of the following to [email protected]

    1) Color copy of Passport or Driver license of Accountholder (both sides).2) Color copy of valid Passport or Driver license of the card holder of each authorized credit card3) Color copy of Authorized Credit Card(s) (both sides).4) Color copy of a Utility Bill, bank statement or credit card statement, not older than two (2) months

    User Name or Customer Number

    Date

    Accountholder Name 

    Accountholder Contact Telephone #1

    Accountholder Street Address, Unit/Suite/Apt Number, City, State, ZIP 

    Accountholder Contact Telephone #2

    By signing below, I authorize the use of the following credit cards ("Authorized Card(s)" for loading my Uptown Aces account identified above. I also agree  that I have been authorized to use all of the Authorized Card(s) listed below and agree to pay any and all charges incurred by these cards to fund my Uptown Aces account, regardless of when or by whom the transaction  was authorized. I agree that you shall be fully protected in honoring any such Authorized Card(s) payments. I further agree that if any such Authorized  Card(s) payment be dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability whatsoever,  including any fees imposed by my bank, even though such dishonor may result in the inaccessibility of my Uptown Aces account. 

    By:

    Signed

    Dated

    Print Name

    Authorized Card (1)

    CARD NUMBER:

    EXPIRATION DATE:

    CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER

    TODAY'S DATE

    Authorized Card (2)

    CARD NUMBER:

    EXPIRATION DATE:

    CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER

    TODAY'S DATE

    Authorized Card (3)

    CARD NUMBER:

    EXPIRATION DATE:

    CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER

    TODAY'S DATE

    Authorized Card (4)

    CARD NUMBER:

    EXPIRATION DATE:

    CARD TYPE

    CARD BILLING ADDRESS: (if different than above)

    CARDHOLDER'S NAME (as it appears on the credit card)

    SIGNATURE OF CARDHOLDER

    TODAY'S DATE

    Question? E-mail [email protected]  

     

    [email protected] 

         VISA                  MASTERCARD              

         AMEX              

         VISA                  MASTERCARD              

         AMEX              

         VISA                  MASTERCARD              

         AMEX               

         VISA                  MASTERCARD              

         AMEX               

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