EmailMe Form - Bad Dog Pictures Credit Card Authorization

Card Holder Name *
First Last
Company Name *
Card Holder Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
E-mail *
Phone *
### - ### - ####
Credit Card Information/Authorization
Credit Card Choice *
Mastercard
Visa
American Express
Card Holder Name *
First Middle Last
Credit Card *

Card Number

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Authorized Amount
Please use the amount listed on estimate.
If you have not received an estimate you may leave this line blank.
We may require an additional credit card authorization with a specific amount once we have a final invoice.
I authorize Bad Dog Pictures to charge the credit card listed for the authorized amount.

I further authorize Bad Dog Pictures to charge the credit card on file as needed to cover additional rental charges and fees including but not limited to any loss or damage of rental equipment.
Signature *
Clear
Date Time *
MM / DD / YYYY