Toll free fax from US: 1-888-579-4555
International fax: +506-296-7467
Scan and e-mail to ccprocessing@casinosupportcenter.com
Please also send a copy of your drivers license or other legal photo ID and a copy of the front and back of each credit card used on your account or you are going to use.
AUTHORIZATION FORM
This is to confirm that I, ____________________________________
(name as it appears on card), have authorized Virtual Casino,
to process electronic charges to my credit card(s) with the following number(s)
via any of their processors. I agree that this authorization and the electronic
record of my transactions held by Virtual Casino shall be used as the final
determination to resolve any dispute regarding past or future transactions. Credit Card #___________________________ Exp. Date _____/_____ Credit Card #___________________________ Exp. Date _____/_____ Address: _________________________________________________________ City : ______________________ State______________ Zip ____________ Phone : ____ -_______ - _______ Fax : _____________________________ Email : ____________________________________ _________________________ ____/____/____ Signature Date