Credit Card Verification and Limit Increase Agreement

To verify a credit card or apply for a limit increase, please complete the agreement below:

  1. For each credit card, enter the account information and print the form.
  2. In the space provided at the bottom of the agreement, make an imprint of your credit card by placing the card under the printed form and very lightly rubbing a pencil over the top.
  3. Sign and date the bottom of the agreement.
  4. Scan or send digital copy via email with the below agreement and accompanied documents:
a copy of picture ID
(e.g. Drivers License)
a copy of the front
of your credit card

 

To avoid processing delays, please ensure that the name, address, card number and signature on your submitted documents are clearly legible.

Client Information

General Information
Credit Card Information
Banking and Credit Information

IMPORTANT: Please read the following carefully before signing and dating.

By submitting this signed and dated form, along with the additional information requested, I am authorizing and fully acknowledging that:

  1. I am the person who opened this account personally, entered into all transactions, and deposited eCash using the above credit card.
  2. I will honor all eCash deposits made in my account and pay for them in full, whether purchases made by telephone or by Internet.
  3. I agree that any and all uncollected purchases or delinquent accounts are subject to 3rd party credit reporting and collections.
  4. I am over 18 years of age
  5. I have read and accepted the terms described in the Transaction Processing Agreement.




Signature Date

Making an imprint of your Credit Card
  1. Place Credit Card under box outline.
  2. Rub pencil very lightly over card.
  3. Ensure that the name, number, and expiration date are clear and readable.

 

Fax To:

+800-1004-2005