EmailMe Form - Credit Card Authorization

Production Company Name *
For *
Rental and deposit
Deposit only
Rental only
Check one *
Only use this card for charges associated with a specific Order Number
Only use this card for charges associated with a specific Job Name
Keep this card on file for future orders
If limiting use to a specific Order Number or Job Name, please enter it below
Credit Card Details *

Card Number

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I authorize Objects to bill my credit card for rental charges, late charges, handling charges and/or loss and damage charges for the order(s) noted above. At the time of shipping, rental fees will be charged to my credit card. Deposits will be run as a "Hold" on funds. I understand that even though I may return my order early, my credit card company my not release funds on a deposit "Hold" for 10 days.
Cardholder's name *
Cardholder's email *
Cardholder's phone number *
### - ### - ####
Cardholder's Address *

Street Address City State / Province / Region Postal / Zip Code
Cardholder's Signature *
Clear
Date *
MM / DD / YYYY