CC Authorization Form

Renter/Account Name*

Please input the legal name of the company or individual who will be responsible for your orders and to whom your orders will be billed. Must match the legal name on all associated paperwork (insurance, tax forms, etc.). (NOTE: If you are renting from us as a company/organization, put that company/organization’s name here, not your personal name or the cardholder’s name.)

Renter Account ID # (if known)

Your ID # (typically a 6-digit number) can be found under “Renter Information” in the top left corner of any NGP Estimate, Rental Form, or Invoice (August 2020 or later).

Phone*

Email*

Photo ID (Cardholder)*

Max. file size: 25 MB.

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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Last 4 Digits of Card

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Notification

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Charge Upon Invoicing (Optional)

Check this box if you would like us to charge all of your orders to this card immediately upon invoicing. Leave unchecked if you plan to use another payment method.

Consent & Certification*

By signing below and by submitting this form, I consent to do business electronically with Nathan Gardocki Productions, LLC (NGP). I also I verify that I am the cardholder (or an authorized agent of the cardholder) and I hereby authorize NGP to put this card on file for the account/customer listed above, subject to the terms and conditions listed in NGP’s Rental Policy and any other applicable agreements. I also certify that I am an authorized officer of the company and/or person(s) associated with this account, and that all the information provided within this form is true, complete, and accurate to the best of my knowledge.

Submitted By*

Signature*

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