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Credit Card Authorization

I,

authorize Marina Veterinary Center to keep my credit card information on file in a secure location in order to expedite the discharge of my pet(s).

This card should be used AUTOMATICALLY for all my billsThis card should be used ONLY WHEN DIRECTEDThis card should ONLY be used for EMERGENCIES with authorization

Below is my credit card information

VISAMASTERCARDCARECREDITAMEX

Credit Card Number

Expiration

Security Code (3 Numbers on the Back)

(AMEX ONLY) Security Code (4 Numbers in front)

Signature

Date

Additional Authorized Users

Additional User

Relation

Additional User

Relation

Additional User

Relation

MVC Staff

Date

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Contact Info

8421 Lincoln Blvd.
Los Angeles, CA 90045
(310) 642-8080
(310) 642-8484

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