Planet 7 OZ Planet 7 OZ

Credit Card Authorization Form

Personal Information:

Full Name:
Address:
City: State:
ZIP Code: Date of Birth(MM DD YYYY)
Day Phone: Evening Phone:

Credit Card Information:

Please enter the details of all credit cards you have used or intend to use at the casino.

Enter the first 8 and last 4 digits of your card in the spaces provided.

Card Number Exp. Date (MM/YYYY)
- - XXXX - -
- - XXXX - -
- - XXXX - -
- - XXXX - -

Return with Copies of Your Credit Cards (Front & Back)

For more information on how your purchases will appear on your credit card statement, please feel free to send us an email or contact us via our Live Casino Support.

I Certify...

I certify that the electronic media record of my transaction held by the Planet 7 OZ GROUP shall be used as the final determination to resolve any dispute I may have. I acknowledge that I have read all the information contained in the Planet 7 OZ GROUP License and agree to abide by all the rules, terms, conditions and agreements therein and as may be amended from time to time.

I also certify that the credit cards listed above have been registered with the Planet 7 OZ GROUP and used there with my full knowledge and consent.

Signature: __________________________________________

Date: / /

MMDDYYYY

Please scan and email the signed and completed form to [email protected]