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    Authorization To Use and Charge Credit Card 1 1

    Uploaded by

    Raine Nathalia Cruzat
    This document authorizes an individual to use a credit card for replenishing their RFID toll account. It provides the credit card holder's details, the subscriber's details, and specifies an auto-replenishment threshold amount. It confirms that the information was voluntarily disclosed, the arrangement can be terminated in writing, and that updated credit card details must be submitted before expiration to avoid termination. Photocopies of the credit card and valid IDs of the card holder and subscriber are required to support the authorization.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Authorization To Use and Charge Credit Card 1 1

    Uploaded by

    Raine Nathalia Cruzat
    803 views1 page
    This document authorizes an individual to use a credit card for replenishing their RFID toll account. It provides the credit card holder's details, the subscriber's details, and specifies an auto-replenishment threshold amount. It confirms that the information was voluntarily disclosed, the arrangement can be terminated in writing, and that updated credit card details must be submitted before expiration to avoid termination. Photocopies of the credit card and valid IDs of the card holder and subscriber are required to support the authorization.

    Original Description:

    RFID

    Original Title

    Authorization-to-Use-and-Charge-Credit-Card-1-1

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    This document authorizes an individual to use a credit card for replenishing their RFID toll account. It provides the credit card holder's details, the subscriber's details, and specifies an auto-replenishment threshold amount. It confirms that the information was voluntarily disclosed, the arrangement can be terminated in writing, and that updated credit card details must be submitted before expiration to avoid termination. Photocopies of the credit card and valid IDs of the card holder and subscriber are required to support the authorization.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    803 views1 page

    Authorization To Use and Charge Credit Card 1 1

    Uploaded by

    Raine Nathalia Cruzat
    This document authorizes an individual to use a credit card for replenishing their RFID toll account. It provides the credit card holder's details, the subscriber's details, and specifies an auto-replenishment threshold amount. It confirms that the information was voluntarily disclosed, the arrangement can be terminated in writing, and that updated credit card details must be submitted before expiration to avoid termination. Photocopies of the credit card and valid IDs of the card holder and subscriber are required to support the authorization.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    AUTHORIZATION TO USE AND CHARGE CREDIT CARD

    ____________________
    Date

    Citra Metro Manila Tollways Corporation


    3/F Toll Operations Building, Doña Soledad Avenue
    Brgy. Don Bosco, Parañaque City

    This is to authorize (Mr./Ms.) _________________________________________("Subscriber") to use, and for Citra


    Metro Manila Tollways Corporation (“CMMTC”) and its Authorized Credit Card Bank Host (“Provider”) to charge the
    Credit Card for the replenishment of the RFID Account based on the details provided below:

    CREDIT CARD HOLDER'S DETAILS SUBSCRIBER'S DETAILS


    Card Holder's Name _____________________________________ Name _____________________________________

    Credit Card Number _____________________________________ RFID Account No. _____________________________________

    Card Type Mastercard Visa AMEx JCB Plate No. _____________________________________

    Issuing Bank _____________________________________ Tel No./ Mobile No. _____________________________________


    Expiry Date _____________________________________ Email Address _____________________________________

    Auto Replenishment 500 (Default) 1,000 3,000 5,000 500 (Default) 1,000 3,000  5,000
    Threshold Amount
    Amount Other Amount (Please specify) ____________ Other Amount (Please specify) ____________

    Further thereto, we hereby confirm that:


    1) The above information for the Prepaid Toll replenishment is voluntarily disclosed.
    2) This Arrangement shall be on a continuing basis unless terminated in writing by the Credit Card Holder,
    Subscriber, and/or by Citra Metro Manila Tollways Corporation.
    3) We are responsible in updating the credit card details by submitting an updated Authorization To Use and
    Charge Credit Card Form with the RFID Customer Service Center within two (2) months prior to the credit card
    expiration date to avoid termination of this Arrangement.
    4) In case a credit card is declined in an automatic replenishment transaction, this Authorization shall be
    terminated automatically without prior notice.

    Attached hereto to support this Authorization are a photocopy each of the front of the credit card and of the respective
    valid IDs (bearing the photo and signature) of the Credit Card Holder and of the Subscriber.

    __________________________________ _____ __________________________________ _____


    Credit Card Holder’s Printed Name & Signature Date Subscriber's Printed Name & Signature Date

    TO BE FILLED OUT BY AUTOSWEEP RFID PERSONNEL


    Received By Processed By
    Date Date
    Branch/Location

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