CREDIT CARD AUTHORIZATION / CREDIT PURCHASE AUTHORIZATION / MONIES ISSUANCE FORM / DEPOSIT LIMIT INCREASE REQUEST
Please send scan copy or digital picture to [email protected]
Important � For your security, you will need to include a photocopy of your credit card(s) and Valid Driver's License or Passport. Your photocopy must be legible to be valid. Try enlarging the copier to 120% for best results.
In order to protect all our customers from unauthorized use of their credit card(s), BingoBilly requires written authorization for online transactions. This information is also used to guarantee that your withdrawal requests are sent to the appropriate recipient thus preventing fraud.
The information received WILL NOT be shared with any other company or third party.
Username |
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First Name (as shown on acct) |
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Last Name (as shown on acct) |
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Address 1 |
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Address 2 |
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City |
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State/Provence |
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Country |
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Postal Code (zip code) |
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Fax Number (type “none” if applicable) |
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Home Phone Number |
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Work Phone Number |
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Fax Number |
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E-Mail Address |
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Date of Birth (mm/dd/yyyy) |
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CREDIT CARD INFORMATION I | |||||||||||
Type of Card |
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Card Number / Account Number (no dashes or spaces) |
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Expiration
Date |
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Name on Credit Card |
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| IF YOU ARE USING MORE THAN ONE CREDIT CARD CLICK HERE | |||||||||||
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| IF YOU ARE USING MORE THAN TWO CREDIT CARDS CLICK HERE | |||||||||||
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I, ____________________________________, do hereby authorize Bingo Billy’s authorized billing agencies, to charge my credit card(s) listed above. As authorized cardholder for the listed credit card(s) I agree to pay any and all charges associated with my personal account using the credit card(s) indicated on this document. I will take every precaution necessary to ensure the security of both my USERNAME and PASSWORD and assume full responsibility for any/all charges associated with my BingoBilly account.
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Signature |
Date |