As part of our effort to provide a secure and hassle free experience we require you to fill out the authorization form below. Please make sure that you sign all pages. All information given to CIRRUS CASINO will be kept strictly confidential. CREDIT CARD AUTHORIZATION FORM: Attention: CIRRUS CASINO - ACCOUNTING DEPARTMENT Toll Free US Fax: 1.800.880.6186 Toll Free UK Fax: +44.207.990.8100 International customers please scan and send to forms@cirruscasino.com I, _________________________________________(name in card), of legal age, card holder of: Card Type:_______________ Card Number:____________________________________ Expiration Date: _____________________ Card Type:_______________ Card Number:____________________________________ Expiration Date: _____________________ Card Type:_______________ Card Number:____________________________________ Expiration Date: _____________________ and residing at ______________________________________________________________________________________________, had authorized the charges that were made to CIRRUS CASINO. By signing this form, I do acknowledge that: • I am aware and do authorize the transactions made to my credit card(s) by CIRRUS CASINO. • I am the legitimate owner of the above mentioned credit card(s). • I acknowledge this purchase(s) and agree that all sales are final and I have read the entire agreement and understand that I will be held fully responsible for its terms and charges and I agree not to chargeback CIRRUS CASINO as long as I receive the services that are defined within the terms of agreement. For verification purposes, I have attached the copy of my Drivers License and copies of the back and front of my credit card(s). I hereby acknowledge that all information that I have provided is true. SIGNATURE: ____________________________________    DATE: ____________________________________ FOR FUTURE PURCHASES: (please choose one) ___ As the credit card holder, I also authorize CIRRUS CASINO to charge my credit card for future purchases verbally or electronically approved by me. Authorization valid until:_________________ Signature / Initials: _____________________ ___ I will send this form again. CIRRUS CASINO can ask again for any other purchases that are not within this authorization form.