Credit Card Payment Authorization Form

    I hereby authorize Hide-A-Way Mini Storage to charge my credit card as follows:

Enter Name Of Customer:

Enter Storage Unit No 1:  Unit 2: Unit 3:  Unit 4:   

Enter Your Name:

Enter Your Email Address:

Enter Your Phone Number (1234567890):

Choose Credit Card Type:

Enter Name On Card:

Enter Card Number:

Enter Expiration Date: Month (MM) Year (YYYY)

Enter ID Code which is the last 3 digits on the back of a VISA/MC or a 4-digit Code on the front of an AMEX card

I Authorize All Seasons To Charge Whatever Amount is Due on the account

-OR-

No, I only authorize the following amount to be charged:

Amount to charge: $

Comments:

By pressing the "Submit" button below I authorize the foregoing charges just as if I was signing a charge slip and agree to pay in accordance with the card issuer's agreement