Bates RV Exchange 4656 Mclntosh Road Dover, FL 33527 813-659-0008 ext 300
Bates RV Rental Deposit 
Credit Card Authorization Form
Remit by fax 813-659-8098 Or by 
e-mail to rentals@batesrv.com

(Please print clearly)
I, ________________________________ hereby authorize Bates RV and / or approved designated
representative to charge my credit card for my RV Rental Deposit in the Amount of $200.00 which will be applied to the charges due at time of rental pick up. I also Authorize this card to be charged upon the return of my rental if security deposit does not cover any charges outstanding to include any tickets or tolls that I received while renting the unit from Bates RV.

[] Master Card  [] Visa [] Discover 

Name on credit card: _________________________________________________________________
Credit card number _________________________________________________________________
Expiration date: _____________ __________ Verification Code: ________
(Month)      (Year)                                   (Last 3 digits on back of card)


Address:__________________________________________________________________
City, _____________________  State, __________  Zip:_________________
Phone:_______________________________________________
 I have read, the above and agree and have filled out the information requested  with the understanding that giving false information is a violation of the law.
X _________________________________________________  Date _______________________