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Credit Card Authorization Form Instructions: Fill in ALL the requested information, print out this page, sign and date the form and fax this page along with a photocopy of the front of an official government issued ID (Drivers License, State ID or Active Military ID) to 702-798-0008.
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| I authorize Emerson Costume to charge my
credit card for the approximate amount of
$______________________________ for the purchase and/or deposit of
sale/rental of
_________________________________________________________________________________. |
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| Card Information | |
| Credit Card Type: | Mastercard Visa Discover American Express |
| Credit Card Number: | |
| Expiration Date: | Month Year |
| Cardholder Name: | |
