Credit Card Authorization Form

In lieu of my credit card imprint, I,  hereby authorize Furniture Connection to bill my Credit Card for the initial 1st month invoice, and all renewal invoices until the furniture has been returned to Furniture Connection.

I fully understand this payment is non-refundable. I understand that my credit card information will be kept on file until the furniture has been returned to Furniture Connection and inspected for damages. In the event that any damage occurred while the furniture was in my possession, I understand that Furniture Connection may bill me for the repair cost or replacement value of the furniture as per Schedule A of the Rental Contract.

Credit card Type:


Card Credit card Number:  

Expiration Date:  

CVV # (3-4 digit # on back of card):  

Cardholder’s Name (as it appears on credit card):  

Card Holder’s Billing Street Address (where credit card statements are sent):  

Card Holder’s Billing Postal Code:  

*For security purposes, and to verify your identity, we may request picture identification such as Drivers License.

Leave this empty:

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Document name: Credit Card Authorization Form
lock iconUnique Document ID: 0ff68689c04a77315e722cf068a3dbb2205a24a7
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April 20, 2022 6:22 pm MDTCredit Card Authorization Form Uploaded by Alex Brovkin - IP