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.

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