Credit Card Holder Information
Full Name:
Are you the owner of the home (or have the authority of the owner to lease this property?):	Yes         No
Property Address:
City:
Zip:
Credit Card Authorization
I hereby authorize Crown Realty and Management Corporation to charge my credit card for their Marketing and Screening Service as outlined herein:
Initial advertising:	Choose One... $149 for 30 days $179 for 60 days $199 for 90 days $17 for revisions
Renewal of current ad:	0.00 $129
Other:
Credit Card use fee:	$5.00
Total:
Credit Card Authorization         Amount:$ Card # Expiration Date: By Typing in your Full name below, you authorize these credit card charges: Today's Date:
Please look over this form carefully since there are no mechanisms set to check the validity of each field. We will not be able to process your payment without all applicable information filled out.
You might want to print this page before submitting so that you will have a record of exactly what information you have given us.

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