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Credit Card Authorization
We accept all major credit and debit cards, but do require the cardholder name match the Leaseholder’s name. If not, we must authenticate the cardholder as a valid payer by completing the form below. This form is to be completed only by the cardholder.
Please enable JavaScript in your browser to complete this form.
Name of Cardholder
*
First
Last
Name on Lease
*
First
Last
Please use only the primary leaseholder's name. If the room is under a business entity name, please use the primary contact person.
Room Number
*
Leaseholder's rented room (e.g. D.3, 14, 105)
Email
*
Cardholder only
Phone
*
Cardholder only
File Upload
*
Click or drag a file to this area to upload.
Please submit a single photo of your primary Payment Method AND valid Driver License together.
Comment or Message
*
Terms & Conditions
*
I agree that my credit card may be used for monthly billing transactions at The Music Box on behalf of the Leaseholder, as evidenced by my current driver license and credit card.
Name
Submit
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