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CREDIT/DEBIT CARD AUTHORIZATION
PERSONAL INFORMATION
Name:
Rental Property Address:
City:
State:
Email:
Phone:
ZIP:
BILLING INFORMATION
Name on card:
Credit card type:
Visa
MasterCard
American Express
Discover
Credit card number:
Expiration:
Verification code:
Cardholder’s billing address:
City:
Initial each
line below:
State:
ZIP:
AGREEMENT
1. By submitting this form, you authorize Entourage Property Management , LLC to use the
credit/debit card number above as payment for the one time payment for the amount of
$___20.00____ plus a convenience fee of 3% for a total amount of $__21.00____.
2. Should the credit/debit card listed above be declined, I agree to provide Entourage
Property Management with an alternative method of payment within two (2) days from the
date of decline.
3. You and/or Entourage Property Management have the right to terminate this agreement at
any time, with thirty (30) days advance notice.
SIGNATURE
Date:
Signature:
Print Name:
Please return this form to your Property Manager, fax it to (800) 704-3038,
or mail it to Entourage Property Management at the address below
Entourage Property Management
PO Box 14903, Long Beach, CA 90803 | (800) 704 -3920 phone | (800) 704-3038 fax | www.entourageetc.com