Credit Check Payment

(Use this form if paying for credit check by credit card; if paying by check, this form is unnecessary.)

Applicant ____________________________________________________

Rental _______________________________________________________

Accepted cards: [ ] Visa [ ] Master Card [ ] American Express
[ ] Discover [ ] Others

Cardholder's name ______________________________________

Card number _____________________________________

Expiration date ______________ Security code ______________

 

I authorize the landlord/manager of the above rental to use the credit card described here to pay for a credit report. This authorization does not cover charges in excess of $____ and will expire on ________________.

 

____________________________ _____________
Signature Date

____________________________
Print name

 

OFFICE USE

Application received __________________________________

No credit check, date decided ________________________________

 

Transaction run for credit report

Transaction date _________________________________

Credit-reporting agency ___________________________

Run by ________________________

Cost ___________________