CHICAGO VAN RENTALS
The Gold Standard in Passenger Van Rentals
3217 W Lake St, Melrose Park, IL 60160
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773-800-9898
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www.chicagovanrentals.com
CREDIT CARD AUTHORIZATION
I, , authorize CHICAGO VAN RENTALS to charge my credit card for rental payments made on behalf of the renter specified below. I agree to pay the full rental payment and also authorize this card to be used for any additional charges including but not limited to tolls, parking tickets, red light camera tickets, damages, extra miles, fuel charges, and deductibles related to this rental.
CARDHOLDER INFORMATION
Name on Card
Billing Address
City / State
,
Zip Code
Phone
Email
PAYMENT DETAILS
Card Type
Exp Date
Card Number
CVV
RENTAL ASSIGNMENT
Renter's Name
From Date
To Date
Cardholder's Signature
Date signed