Credit Card Authorization

I HEREBY AUTHORIZE BANYAN BAY MARINE CENTER TO USE THE PROVIDED PAYMENT INFORMATION (IN MY ABSENCE) FORTHE SOLE PURPOSE OF PAYING THE STORAGE FEE AND SUCH OTHER CHARGES FOR PRODUCTS AND SERVICES RENDERED,AND WILL NOT DISPUTE THE CHARGES, BY SIGNING BELOW:

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Last Name*:
First Name*:
Card Type*:
Card Number*:
VV2 Security Code*:
Expiration Date*:



Complete below at Banyan Bay Marina Office:


☐ I Agree to the terms and conditions.
Owner(print): Signature: Date:
RECEIVED AND APPROVED BY: Banyan Bay Representative Date: