Cardholder’s Name definition

Cardholder’s Name. (Please print): Address of cardholder: Authorized Signature:

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Cardholder’s Name. Card Expiry Date: /

Cardholder’s Name. Signature: Credit Card Number: Address: Zip Code: Expiration Date: Security Code: ▇▇▇▇▇ Van Den Brulle will be credited as vendor. Full mention of ▇▇▇▇▇ Van Den Brulle’s design firm is necessary. Please include full mailing address (▇▇▇▇▇ Van Den Brulle, ▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, New York, NY 10012 Tel: ▇ (▇▇▇) ▇▇▇ ▇▇▇▇, ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇) The listed item(s) above are being released for rental / loan to said client (Stylist, Publisher, Set, Photographer, Credit Card(s), and Insurance Company) above. Item(s) listed will be returned and in the gallery on said date above. Item(s) on rental / loan from ▇▇▇▇▇ Van Den Brulle will undergo a thorough inspection before leaving the gallery and upon return. If any damage is found to the piece(s) upon return to the gallery, said client above will be responsible for all repairs and credit card on file will be charged, this transaction will be final. ▇▇▇▇▇ Van Den Brulle’s rental / loan policy is subject to conditions listed on following page. The renter(s) / loan signer and or Insurance Company will be held fully responsible for all damages and to the items mentioned above. Full payment will be charged for items that cannot be repaired. By signing this form you agree to all terms and conditions stated above and referenced in

Examples of Cardholder’s Name in a sentence

• No such making of an L/C Advance shall relieve or otherwise impair the obligation of the Borrower Representative to reimburse the relevant L/C Issuer for the amount of any payment made by such L/C Issuer under any Letter of Credit, together with interest as provided herein.

• Shipping Address City Province Postal Code Mentor’s Name Mentor's ID Optional Starter Sets (REFER TO COVER SHEET FOR PRICE(S) $ (FLAT RATE) SHIPPING $9.95 SUBTOTAL $ (Subtotal x %) Applicable GST/ HST/ QST/ PST $ (Subtotal + Applicable GST/HST/QST/PST) ORDER TOTAL $ American Express Visa MasterCard Cardholder’s Name Phone Card No. Expiration Date CVV Authorization Signature Date Date Rec’d.

• Please charge my credit card: (circle one) VISA Mastercard American Express Card No: Expiration Date: Security Code Cardholder’s Name: BUSINESS PARTNERS RIGHTS/FEE In consideration of the right to be identified and acknowledged as a Platinum Level AANAC Business Partner and to receive the Benefits of this partnership, Business Partner agrees to pay the fee to AANAC in the amount of $6,000 (Business Partner Fee).

• METHOD OF PAYMENT VISA 🞏 MC 🞏AMEX 🞏DISC Cardholder’s Name Card Number Exp.

• Issuing Bank: Expiration Date: Cardholder’s Name: CVV # (As shown on credit card) Address: Phone No: Customer’s Signature Print Name Date ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇▇, ▇▇.

• Issuing Bank: Expiration Date: Cardholder’s Name: (As shown on credit card) Address: Phone No: Customer’s Signature Print Name Date ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇▇, ▇▇.

• Cardholder’s Name: Cardholder’s Signature: ❑ MasterCard® ❑ VISA® ❑ American Express® ❑ Discover® Card Number Exp.