Credit Card Authorization Form

Credit Card Authorization Form

Please fill out this form to sign up for recurring payments or to pay your lease in full.
Cardholder Name *

First Name Middle Name Last Name Suffix

Entire Lease Amount ( USD one-time payment)

Please compare this number to the number on your lease agreement.

Monthly Rent ( USD for each month )

Please compare the subscription amount to reflect the same on your lease agreement.

Recurring payments

Payment Method

ConditionText
I, {cardholderName}, as a cardholder, hereby authorize KJSTAYS (ABOSS LLC) to charge my credit card for {conditiontext} and confirm that the information for the credit card and billing address is complete and accurate. I have been informed that I can cancel the recurring payment at least 15 days before the payment by phone or signing a consent form provided by the merchant company.
Date *

Month Day Year
Date
Cardholder Signature *

Clear
Should be Empty: