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PAYMENT TO: Andy Card Rental


* Required Fields


Booking Code/Number *
AUTHORIZED TRANSACTION AMOUNT* $

PERSONAL DETAILS

Company/Organization Name:
First Name:*
Last Name:*
Email:*
Re-enter Email*:
City:*
State:*
Country:*

CREDIT CARD BILLING ADDRESS
 
Address*
City*
State*
Country*
Zip Code*
Card Type*

 

Card Number*




for ex: 1234123412341234
*do not include dashes or symbols

Card Exp. Date*
Month(mm) Year(yyyy)For Ex: (01-2019)
CVN (?)*
 

Please read these Terms & Conditions and Check the box to indicate you agree to these terms and conditions.

I AUTHORIZE ANDY CAR RENTAL TO CHARGE THE CREDIT CARD MENTIONED IN THIS FORM ONLY FOR THE AMOUNT NOTED ABOVE/PRIOR AND FOR THIS ONE TIME ONLY. I UNDERSTAND THAT I WILL NOT BE PROVIDED WITH AN ACTUAL TRANSACTION SLIP / RECEIPT YET, SINCE THIS AUTHORIZATION IS ON-LINE, AND THOUGH I AM NOT SIGNING TO CONFIRM THIS TRANSACTION, I DO AUTHORIZE IT AND HEREBY WAIVE A SIGNATURE REQUIREMENT. I UNDERSTAND THAT I AM RESPONSIBLE FOR THE AMOUNT BEING CHARGED TO MY CREDIT CARD FOR THE PRODUCT OR SERVICE I AM PURCHASING. ANDY CAR RENTAL WILL NOT DISTRIBUTE ANY INFORMATION RETRIEVED IN THIS FORM. BY ENTERING THE AMOUNT IN THE PRIOR PAGE, YOU HAVE CONFIRMED THAT YOU ARE AWARE OF A PURCHASE THAT YOU ARE MAKING VIA THIS CREDIT CARD TRANSACTION. ALL TERMS AND CONDITIONS OF THE "SALE" ARE SEPARATE FROM THIS AUTHORIZATION. PAYSYSTEMZ, A SERVICE-BASED DIVISION OF A GUAM-BASED WEB SERVICES PROVIDER, IS NOT IN ANY WAY LIABLE OR RESPONSIBLE FOR ANY DAMAGES OR LOSSES INCURRED OR ASSOCIATED WITH THIS CREDIT CARD TRANSACTION. (READ MORE ABOUT PAYSYSTEMZ'S ROLE IN THIS TRANSACTION, BY CLICKING HERE).


I agree and accept the Terms & Conditions above and Disclaimer, Use of Services, and Indemnification below.

PLEASE CLICK "SUBMIT" TO SEND US YOUR AUTHORIZATION.
You must agree and accept the Terms & Conditions above and Disclaimer, Use of Services, and Indemnification below to be able to click "Submit"
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