Credit Card Authorization Form

1. Cardholder Information

Please fill out the following information to authorize payments for equipment rentals. All information will be kept confidential and secure.

  • Full Name (as it appears on the card):
  • Billing Address:
  • City, State, Zip Code:
  • Phone Number:
  • Email Address:

2. Credit Card Information

  • Credit Card Type (Visa, MasterCard, Amex, etc.):
  • Credit Card Number:
  • Expiration Date (MM/YY):
  • CVV Code (3 or 4 digits):

3. Authorization for Payment

By completing and signing this form, you authorize J&J Equipment Rental to charge your credit card for the amount(s) agreed upon for equipment rental services. You also agree to the following terms:

  • I authorize J&J Equipment Rental  to charge my credit card for all rental charges, including but not limited to rental fees, delivery fees, damage costs, and any additional fees specified in the Rental Agreement.

  • I understand that my card will be charged on the first day of the rental period unless otherwise agreed upon.

  • I agree that any damages, losses, or extra rental time may result in additional charges to my card after the equipment is returned.

  • In case of late payment, I understand that a 1.5% late fee may be applied to the outstanding balance each month.

4. Cancellation Policy

I acknowledge that cancellations made less than 48 hours before the rental start date will incur a 50% cancellation fee as outlined in the Rental Policies. No refunds are issued for rentals cut short unless otherwise agreed upon.

5. Agreement to Rental Terms

I, the undersigned, confirm that I have read, understand, and agree to the Rental Policies and Credit Card Authorization terms. I also agree to abide by all the terms and conditions set forth in the rental agreement.

Cardholder’s Signature:

Date: _______________

Print Name:

6. Authorization for Future Rentals (Optional)

I authorize J&J Equipment Rental to keep my card on file for future rentals. Charges will only be made with my prior approval.

  • Yes [ ]
  • No [ ]

7. Confidentiality and Data Protection

We take your privacy seriously. Your credit card information will be used solely for the purpose of this rental agreement and will not be shared with any third party. We employ industry-standard encryption and security measures to ensure your information is protected.