Credit Card Authorization

Text Box:

1. Charges to Credit Card: The undersigned (a) has rented certain equipment (“the Equipment”) from CESCO for a specified rental period (“the Rental Period”); and/or (b) may purchase certain equipment, tools or accessories from CESCO. In the event that the undersigned (a) extends the Rental Period; or (b) fails to return the Equipment at the expiration of the Rental Period; or (c) purchases any equipment, tools or accessories, the undersigned, in lieu of a security deposit, hereby authorizes CESCO to charge any and all costs associated with the rental of the Equipment and/or the purchase of any equipment, tools or accessories, including, but not limited to, any and all daily, weekly or monthly rental charge(s), purchase price(s), finance charges at the rate of one and one half percent (1½%) per month on all unpaid balances, damage waiver(s), damages, costs incurred in retaking the equipment, repair costs and replacement costs, to the following credit card:

1. Type of Card: _________________________ (Visa, MasterCard, etc)

2. Card Number: ___________________________________________

3. Customer Code: __________ (3 digit # on back or 4 digit on front w/Am Express)

4. Expiration Date: ________ / __________

5. Name on Card: ____________________________________________

6. Company (if applicable): ____________________________________

7. Mailing Address for Card:____________________________________

2. Attorney’s Fees and Costs: In the event any legal or arbitration preceding is commenced for the purpose of interpreting or enforcing this Authorization or to collect any amounts due, the prevailing party shall be entitled to recover a reasonable attorney’s fee and related expenses in that legal or arbitration proceeding, or any appeal thereof, in addition to the costs and disbursements allowed by law.

__________________________________________ __________________

Signature of Lessee/Purchaser DATE