Credit or Debit Card Payment Authorization Form

Credit or Debit Card Payment Authorization Form

3107 Cove Ave | 541-910-4438 | www.cstoragelagrande.com
Set up your initial payment or one-time charge using your debit or credit card. Just complete this form and get started.
This authorization form is for the following unit(s)*
I authorize C’s Storage to automatically debit the monthly rent for the unit(s) shown above from my credit or debit card or bank account as detailed below. *

First NameLast Name
First month rental amount and one-time move in fee is:*
There is a small one-time courtesy fee added to your payment. This amount goes directly to the debit/credit card processing company. It is 2.99% off the first month rent and set up fee.
Renter's Phone Number*

Area CodePhone Number
I understand that I will be notified in writing, as set forth in the Rental Agreement, if the rental amount due for my unit(s) changes, and that amount debited monthly will reflect the effective rate. This authorization will remain in effect until termination in writing.

We reserve the right, with advance written notification, to terminate your participation in this payment option. If an automatic debit is refused for any reason, including over-credit-limit charges, closed or unauthorized account, insufficient funds or incorrect expiration dates, we will not be able to process payment. In this event late charges as set forth in the Rental Agreement will be charged, and you will be required to provide an alternate method of payment.
After hitting SUBMIT you will be redirected to our secure Credit Card Authorization form, to record your cc number for future payments.
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