Credit Card Authorisation Form Please complete all fields. You may cancel this authorisation at any time by contacting us. This authorisation will remain in effect until cancelled. Credit Card Information Card Type: ☐ MasterCard ☐ VISA ☐ AMEX ☐ Other ___________________________________________ Cardholder Name (as shown on card): ___________________________________________ Last 4 digits of Card Number: ___________________________________________ Expiry Date (mm/yy): ___________________________________________ I, _______________________________, authorise __________________________________ to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.
The word Scooter Hire and its figurative a registered trademarks in Australia