Authorization for Credit Card Use


SANTA MONICA FLYERS

3165 Donald Douglas Loop S. • Santa Monica, CA 90405 • 310.800.8050

Authorization for Credit Card Use

COMPLETE AND SIGN THIS AUTHORIZATION AND RETURN.
All information herein will remain confidential


Name on Card:   

Billing Address:   

Credit Card Type:   

Credit Card Number:   

Expiration Date:   

Card Identification (CVV) Number:   
(last 3 digits located on the back of the credit card)

I hereby authorize Santa Monica Flyers, Inc. (SMF) to charge the above credit card any time
I incur a balance on my customer/renter account, that I don’t pay myself, upon the
completion of my flight or ground school lesson. I agree to pay balances owed, with the
above credit card, for flight instruction, airplane rental, landing fees, pilot supplies, or any
other charge I incur, as a result of services or goods I have acquired at SMF. I agree to pay
for this purchase in accordance with the issuing bank cardholder agreement. I also
understand billing disputes will be resolved within 30 days of my notifying SMF in writing and
that any refund issued to resolve billing disputes, will be issued via check.

Date: 

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Authorization for Credit Card Use
lock iconUnique Document ID: 9abda3bcfea4a916ea36d1572c4445ba39032e10
Timestamp Audit
September 15, 2020 6:33 pm PDTAuthorization for Credit Card Use Uploaded by Santa Monica Flyers - shelbykrzastek95@gmail.com IP 67.49.108.220