Instructions: After this form is completed and hand-signed, send scanned copies to [email protected] . Please complete ONE form for every Credit Card you’ve used to deposit, and send it along with:
· Clear copies (front and back) of the credit card used;
· Government issued personal identification (driver’s license or passport)
· If you’re unable to provide any of the documents above, we also accept a Recent Utility Bill and the Credit Card Statement from your Bank
Please ensure all documents are readable. We recommend enlarging documents to 120%. For assistance please contact Documents Support at [email protected] .
Sports Betting Credit Card Authorization
CREDIT PURCHASE AUTHORIZATION / MONIES ISSUANCE
PERSONAL INFORMATION
Name (as on account): _______________________________________ Customer ID:____________________
Date of Birth (mm / dd /yyyy ): ____ / _____ / ______
Address:_______________________________________________________________________________________
City ______________________________________State/Province ______________________________________
Zip/Postal Code ___________________________________Country ____________________________________
Phone: ( ______ ) ___________________ Employer ______________________________________________
BANKING INFORMATION
Type of Card: ( ) VISA ( ) MASTERCARD Other: _______________
Credit Card Number: _______________________________
Expiration Date: ( mm / yy ): _____ / ______ CVV code: _______________
Name as shown on card: _________________________________________________________________
Bank Name _______________________________________________________________________________
Bank Phone ( _____ ) _______________________
Please accept this as authorization for sportsbetting.com, to draft the above listed credit card and continue such authorization until I notify sportsbetting.com and the bank listed in writing.
I hereby certify and attest that I am the authorized cardholder and agree to pay for the charges on the card above listed. I authorize
Sportsbetting.ag or any other billing agency which
Sportsbetting.ag uses and notifies me of, to charge my credit card by any instance that I verbally authorize over their recorded telephone lines or for any online eCash purchased by me for my
Sportsbetting.ag account. I further agree that these charges are final and irreversible.
______________________________________ _____/______/______
Authorized Signature Date
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