Security Deposit Credit Card Payment Authorization Form

Print, fill in and sign this form to authorize Brian Testo Associates, LLC (BTA) to debit to your credit card listed below for the auction Security Deposit.

By signing this authorization, you acknowledge and agree that:

a.  You are the person described herein.

b.  BTA has permission to debit your account for the amount indicated below on or after the indicated date.

c.  The Security Deposit is NOT an acceptable form of final payment for invoice.

d.  The Security Deposit is fully refundable if you are not a successful bidder or after your invoice is paid.

e.  Credit card authorizations are subject to a 3-7 hold on funds with your credit card company, which hold is not under the control of BTA to release.

f.  In the event you fail to pay your entire invoice, BTA can retain the security deposit as liquidated damages.

g.  The $25 processing fee is non-refundable.

h.  Acceptable Forms of Final Payment are Cash, Cashier Check and Wire transfer only.

i.  This permission is a single transaction only, and does not provide authorization for any additional debits to your account.

Once complete please return this signed form along with copies of the front and back of your credit card and valid driver’s license to: If you have any question call 818-592-6592 x 107

Please complete the information below:

I ______authorize Brian Testo Associates, LLC to charge my credit card

(full name)
account indicated below for $1,025.00 on or after ______. This payment is for

(amount) (date)

$1,000 refundable security deposit plus non-refundable $25 processing fee.

(description)


Billing Address ______Phone# ______

City, State, Zip ______Email ______

Account Type: Visa MasterCard AMEX
Cardholder Name ______
Account Number ______
Card Identification Number ______(3 or 4 digits found on front or back of credit card)
Expiration Date ______

SIGNATURE DATE

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the security deposit and processing fee for Brian Testo Associates, LLC auction, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.