CREDIT TRANSACTION VERIFICATION FORM

Re: Credit Verification and Credit Limit Notice

After careful review of your online account, we would like to inform you that you have reached your maximum credit card limit and in order for us to increase your limits using your credit card we would like for you to verify your account.

You are a valued customer, and as such, you are entitled to get a free chip or a percentage of your losses upon receiving this form.

KNOW ALL MEN BY THESE PRESENTS:
That the undersigned does hereby certify the following:

    1. That I, _________________________(NAME ON THE ACCOUNT), alias(es) _______________________________________the undersigned is transacting online with Emoney Processing Limitedand its affiliates.

    2. That all transactions were made using the following credit card(s) are acknowledged and authorized by me.

Credit Card: ________________________exp date: ________

Credit Card: ________________________exp date: ________

Credit Card: ________________________exp date: ________

Credit Card: ________________________exp date: ________

And that I am the legal card holder of the above mentioned credit cards.

Billing address: _______________________________________________________________________________________________________

    1. That I acknowledge this purchase(s) and agree that all sales are final. I acknowledge that I have read the entire agreement and understand that I will be held fully responsible for its terms and charges as defined within the terms of agreement; and Purposes of verification, I am attaching the copy of the cards used and the copy of a legal photo ID together with a copy of my utility bill.

    2. And that for any further purchases let it be known that: (choose one)
      Any future purchases, I authorized to charge my credit card for purchases ONLY WHEN IT IS verbally or electronically approved by me.

This Authorization valid until _____/_____ Signature/Initials: ______________

OR

I will send this form again for any other purchases - Signature/Initials: ______________

As agreed and acknowledged:

 

Signature_____________________________
(Clearly print name after signature)

SIGN AND SEND FORM TO:

Credit Card Processing Department
Toll Free fax number: 1888 579 4555
Scanned forms send it to: ccprocessing@casinosupportcenter.com