CREDIT CARD AUTHORIZATION FORM UPTOWN ACES
Email this Form along with copies of the following to documents@uptownaces.eu
1) Color copy of Passport or Driver license of Accountholder (both sides).
2) Color copy of valid Passport or Driver license of the card holder of each authorized credit card
3) Color copy of Authorized Credit Card(s) (both sides).
4) Color copy of a Utility Bill, bank statement or credit card statement, not older than two (2) months
User Name or Customer Number
Accountholder Contact Telephone #1
Accountholder Street Address, Unit/Suite/Apt Number, City, State, ZIP
Accountholder Contact Telephone #2
By signing below, I authorize the use of the following credit cards ("Authorized Card(s)" for loading my Uptown Aces account identified above. I also
agree that I have been authorized to use all of the Authorized Card(s) listed below and agree to pay any and all charges incurred by these cards to
fund my Uptown Aces account, regardless of when or by whom the transaction was authorized. I agree that you shall be fully protected in honoring
any such Authorized Card(s) payments. I further agree that if any such Authorized Card(s) payment be dishonored, whether with or without cause and
whether intentionally or inadvertently, you shall be under no liability whatsoever, including any fees imposed by my bank, even though such dishonor
may result in the inaccessibility of my Uptown Aces account.
CARD BILLING ADDRESS: (if different than above)
CARDHOLDER'S NAME (as it appears on the credit card)
CARD BILLING ADDRESS: (if different than above)
CARDHOLDER'S NAME (as it appears on the credit card)
CARD BILLING ADDRESS: (if different than above)
CARDHOLDER'S NAME (as it appears on the credit card)
CARD BILLING ADDRESS: (if different than above)
CARDHOLDER'S NAME (as it appears on the credit card)
Question? E-mail documents@uptownaces.eu
