Credit Card Verification Form

Quality Furniture Rental Credit Card Verification Form
Toll Free Number: 1-800-547-5852
Fax Number: 651-487-2675

Quality Furniture Rental Credit Card Verification Form

Permission to Charge Credit Card:
I give you, Quality Furniture Rental, irrevocable and continuing permission to make charges to this credit card and renewals of it. I promise to pay such charges to the issuer of the credit card without dispute. The charges will be for the amounts due under my lease(s) with you, any subsequent adjustments to it (them), and any amounts due at the termination of my lease(s). Charges might include but not limited to: monthly charges, late charges, transportation fees, and replacement, repair, or purchase of merchandise.
Please select one of the following options:*
- Please routinely charge my card monthly on due date (date of your delivery)
- Please charge the initial payment due before delivery only.
- Please charge my credit card only if my account(s) become delinquent (will also include late charges after five days of your due date)
Credit Card Type*
- Visa
- MasterCard
- American Express
- Discover
Credit Card Account Number*
CVV Number*
3 or 4 digit number on your card. Typically on the back of your card. AMEX uses a 4 digit number on the front of the card.
Card Expiration Date*
Example: 01/2019
Name as it appears on card*
Billing Address*
Street Address Address Line 2 City State ZIP Code
DRIVER’S LICENSE VERIFICATION FORM
ATTENTION: MUST UPLOAD A COPY OF PHOTO I.D.
Name*
State of Issuance*
State
Drivers Licence #
Drivers License #*
Drivers License Expiration Date*
Example: 01/2019
Upload a Copy of Your License*
Accepted file types: jpg, gif, png, pdf.
Scan or take a picture of your license and upload it as a jpg, gif, png or pdf file type.

Quality Furniture Rental Credit Card Verification Form

Permission to Charge Credit Card:

DRIVER’S LICENSE VERIFICATION FORM