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ARMANDA COSTANZA, INC.
Printable Version of the
 Credit Card Authorization Form
 


Please read the and submit your e-signature and information at the bottom of this form for the Credit Card Signature Authorization.
 

Credit Card Signature Authorization

 


NEW CUSTOMER PAYMENT TERMS:
 

ALL NEW CUSTOMERS ARE REQUIRED TO USE OR MAKE AVAILABLE A CREDIT CARD FOR THEIR FIRST CAMERA RENTAL.

YOUR CARD WILL BE PRE-AUTHORIZED FOR THE AMOUNT OF THE CAMERA RENTAL.

NEW CUSTOMERS CAN CHOOSE TO PAY BY CHECK, BUT IF THAT CUSTOMER REACHES PAST DUE STATUS, THE CREDIT CARD WILL BE

USED TO PAY FOR THE CAMERA INVOICE. PLEASE COMMUNICATE YOUR FINAL PAYMENT METHOD TO YOUR RENTAL AGENT OR THE

CAMERA RENTAL ASSISTANTS.

ALL NEW ACCOUNTS RECEIVE NET 10 TERMS.

NET 30 TERMS ARE ONLY AVAILABLE IF YOU FILL OUT A FULL CREDIT APPLICATION 5 DAYS IN ADVANCE OF YOUR CAMERA RENTAL.

CREDIT HAS TO BE APPROVED BEFORE NET 30 TERMS ARE GIVEN

 

EXISTING CUSTOMERS:
 

YOU MUST DISCLOSE THE NAME OF THE PARTY RESPONSIBLE FOR FINAL PAYMENT OF THE CAMERA RENTAL BEFORE THE EQUIPMENT

LEAVES THE PREMISES OF AC INC.

NO SWITCHING BETWEEN PAYEES! THIS COMPLICATES INSURANCE RESPONSIBILITIES AND COLLECTIONS!

THE PERSON TAKING POSSESSION OF THE EQUIPMENT WILL BE RESPONSIBLE FOR ANY PAST DUE INVOICES THAT ARISE.

IF YOU ARE USING INSURANCE THROUGH ANOTHER COMPANY YOU MUST DISCLOSE THIS AND THEY MUST GIVE WRITTEN CONSENT FOR

YOU TO USE THEIR INSURANCE.

NEW/EXISTING CUSTOMERS WITHOUT INSURANCE ARE REQUIRED TO PROVIDE A CREDIT CARD TO COVER THE FULL VALUE OF

EQUIPMENT RENTED. YOUR CARD WILL BE AUTHORIZED. IF EQUIPMENT IS RETURNED DAMAGED THE CARD WILL BE CAPTURED FOR THE

AMOUNT OF THE DAMAGE

.

INSURANCE INFORMATION:

 

A CERTIFICATE OF INSURANCE IS REQUIRED covering all rented equipment.

Please list as follow: Armanda Costanza Inc. – 220 Great Circle Rd. Suite 138, Nashville, TN 37228

Ph: 615.256.2663, Fax: 888.273.4125. Armanda Costanza, Inc. must be listed as “Loss Payee” and additional insured. (No exceptions)

 

 
ONLINE ELECTRONIC SIGNATURE

The Credit Card Authorization form is good for one year and will be used for jobs occurring from this date of signing till 365 days have
occurred.

If the (*) required information below is not filled out, the Credit Card Authorization from will be voided.

THIS IS AN INTERACTIVE FORM, PLEASE TYPE YOUR INFORMATION INTO THE SPACES PROVIDED:
 
*YES, This is to certify that I, ,have read, understand, and agree to all of the information on this document. I agree to abide by these terms for my equipment rental needs.
I further understand and agree to comply with the terms and conditions stated above. I also understand and agree to conduct this business electronically with Armanda Costanza, Inc. and that through the typing of my name and by selecting the "Submit My Electronic Signature" at the end of this page constitutes my electronic signature and formalizes the Agreement between me and Armanda Costanza, Inc. I further understand that my electronic signature is legally binding under Federal law. When this document is submitted, my IP address and a timestamp specifying the date and time of this Electronic Agreement will automatically be attached to the submitted document.
 
*Type in the company name:
*Cardholder's) Name
*Type of Card:
*Credit Card Number:
     
*Expiration Date:
*Credit Card Billing Address:
*City:  
*State:
*Zip:
*Phone:
Ex: (999-999-9999)
*Email:
*Date:
If you have questions regarding the Credit Card Signature Authorization please call 615.256.2663 Ext. 5  and speak with Lisa Byrd.
Thank you!

 
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