Month/Year
a. The information provided in the Agreement is credible and accurate.
b. My Eclipse account was registered using my personal information and all transactions were initiated and authorized
personally, using the credit card being subject to the present Verification Agreement.
c. All transactions made in my account will be paid in full.
d. All uncollected purchases or delinquent accounts are subject to 3rd party credit reporting and collections.
e. I am over 18 years of age.
f. I have read and agreed to the terms set out in the Transaction Processing Agreement.
Registered Email Address:
Credit Card Number:
Expiration Date:
IMPORTANT: Please read the following carefully before signing and dating the Agreement.
Please note that the Agreement and the above-mentioned documents must be submitted for each credit card used
for the Casino banking:
To verify your credit card, please send a color photo of the completed, signed and dated Agreement
below to verification@eclipsecasino.com and attach the following documents:
1. Color photo of the front and back sides of the credit card used for making deposits at Eclipse Online Casino.
IMPORTANT: The Company requires only first 6 and last 4 digits, the expiration date, the card holder's name on the
front and the signature on the back. The rest can be covered.
2. Color photo of a valid government-issued photo ID (e.g. driver’s license, passport, permanent resident card);
Please note that the Agreement and the above-mentioned documents must be submitted for each credit card used for
the Casino banking.
To avoid processing delays, please ensure that your name, address, credit card number and signature on the
submitted documents are clearly legible.
Card Holder Information
Full Name:
Signature:
Date:
Credit Card Authorization Agreement
