Credit Card Authorisation

1. BUSINESS DETAILS:

Legal Entity:
Other  
Full Legal Name:
Trading Name:
ACN:
ABN:
Postal Address:
Office Ph:
Mobile:
Email:

2. BUSINESS OWNERS/DIRECTOR DETAILS:

Full Name:
Full Name:
Mobile Ph:
DOB:
Mobile Ph:
DOB:
Drivers License No:
Drivers License No:
Private Residence:
Private Residence:

3. JOB DETAILS:

Date:
Start Time:
Order Number:
Site Address:
Site Contact Name:
Mobile Ph:

4. PAYMENT ARRANGEMENT

Payment Terms:
PAYMENT MAY BE TAKEN PRIOR TO RELEASE OF PLANT
Payment Method:
Credit Card
Credit Card Details:
Credit Card Type: (Please Select):
Card No:
Name on Card:
Expiry Date:
CVV No:
Signature:

CREDIT CARD DETAILS ARE COMPULSORY FOR EQUIPMENT HIRE

5. I understand that my credit card will be charged the anticipated costs of the hire period as well as any other costs associated with the hire. Furthermore, it is imperative that there will be sufficient funds to charge before hire.

6. AGREEMENT (To be completed & signed by signatories in Section 2)

The Hirer’s signature acknowledges that the Hirer has read, understood and agreed to this contract and the Terms & Conditions of Hire attached here to.

Full Name:
Full Name:
Signature:
Signature:
Position:
Position:
Date:
Date:
TERMS & CONDITIONS OF HIRE