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BILL TO AMOUNT
ATTN: Name / Department
Company Name
123 Main Street
Hamilton, OH 44416
(321) 456-7890
Email Address
SUBTOTAL
OTHER
TOTAL
THANK YOU
RENTAL INVOICE
YOUR LOGO PAYMENT TYPE
CREDIT CARD
CARDHOLDER NAME
I authorize the above named business/individual to charge the credit card indicated in this authorization form
according to the terms outlined above. This payment authorization is for the goods/services described above, for
the amount indicated above only, and is valid for one (1) time use only. I certify that I am an authorized user of this
credit card and that I will not dispute the payment with my credit card company; so long as the transaction
corresponds to the terms indicated in this form.
CARDHOLDER
DATE
SIGNATURE
BANK DRAFT
NAME ON ACCOUNT
STREET ADDRESS
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