Name on reservation_____________________________________
Date of reservation___________________
Billing address__________________________________________City_______________State_____
Contact phone #___________________Alternate phone #____________________
CC TYPE__________CC #_________________________EXP DATE________
By signing this form you are authorizing the following charges unless other forms of payment have been made:
•$100 ($200 for H2 Hummer) non-refundable deposit for all reservations
•Full payment of billed invoices after 15 days of the date of the invoice
•Any incurred additional charges including but not limited to:
1.Rental overages…………………….. TBA
2.Excessive Cleaning………………… $50
3.Sickness.……………........................ $300
4.Broken/lost glasses………………… $8
Remaining payment is due in full prior to the start of rental.
Cardholder signature___________________________________________
Cardholder printed name________________________________________
DATE_____________________
*PLEASE ATTACH A COPY OF THE FRONT AND BACK OF THE CREDIT CARD*
