CREDIT CARD AUTHORIZATION FORM
 

I _________________________  (full name as it appears on the credit card)

Hereby authorize Jada1 Pty. Ltd. to debit my credit card up to the value of $1,000 in the case there is any loss or damage sustained to the apartment

□ Unit _____ / 22 Central Ave, Manly, 2095, NSW

□ Unit _____ / Alexander St, Collaroy, 2097, NSW

and/or its contents as a result of any incidents occasioned by myself, or those occupying the apartment with me during the dates:
Check in on __________ 2015, check out __________ 2015.

Credit card type: □ VISA, □ Mastercard

Card Number___________________________________________

Expiration MM/YY _____/________

Card Verification Number _____________

Please enter the Billing address listed on the credit card:

_____________________________________________

_____________________________________________


I certify I am the bank authorized signer/cardholder for the above credit card and agree to the conditions described above.

Signature____________________________  Date______________