Authorization Agreement amp Account Verification [608479]
11/11/2020 Authorization Agreement & Account Verification
https://mega7s.com/CCAuthForm 1/1Click to PrintTo verify a credit/debit card or apply for a limit increase, please complete the agreement below:
1. For each credit/debit card used, enter the account information below and print the agreement.
2. Sign and date the bottom of the agreement.
3. Email the completed agreement along with:
Front and back copies of credit/debit cards used to deposit at the casino. Please block the middle digits so that
only the first 6 and last 4 digits appear, e.g. 123456xxxxxxx1234. Enlarge to 120% for best results./li>
Copy of a recent proof of address no older than three (3) months such as a utility bill or bank statement.
Front and back copy of a valid government issued identity document such as a driver’s license or passport.
Authorization Agreement & Account Verification
By submitting this signed and dated form, along with the additional information requested, I am authorizing and fully
acknowledging the following:
1. I am the authorized cardholder and will honor all purchases initiated by me to my account whether completed by
telephone or Internet
2. I certify that the information provided and supporting documentation is truthful and accurate
3. I am of age of majority (21 years or older depending on your jurisdiction)
4. I have read and accepted the terms of use as listed elsewhere on this website
Please enter your information below.
Customer Account ID:
Full Name:
Phone:
Email:
Card Number (First 6 digits of card):
Card Number (Last 4 digits of card):
Card Expiration Date: Month Year
Issuing Bank Name: Signature: _______________________________ Date
Issuing Bank Phone: Toll free # on back of card
I hereby understand and authorize the above as evidenced by my signature below.
Signature: _______________________________ Date: _________________
Please enter all secondary card numbers in the block below. Please ONLY enter the first 6 and last 4 digits. E.g.
123456*****1234
Please complete, scan and EMAIL to: [anonimizat]
ONLY enter the first 6 and last 4 digits. E.g. 123456*****1234.
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