BingoBilly

CREDIT CARD AUTHORIZATION / CREDIT PURCHASE AUTHORIZATION / MONIES ISSUANCE FORM / DEPOSIT LIMIT INCREASE REQUEST

Please Complete and Fax to: 1–877–291–2424
or send scan copy to cashier@bingobilly.com

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Important For your security, you will need to include a photocopy of your credit card(s) and Valid Driver's License or Passport. Your photocopy must be legible to be valid. Try enlarging the copier to 120% for best results.

In order to protect all our customers from unauthorized use of their credit card(s), BingoBilly requires written authorization for online transactions. This information is also used to guarantee that your withdrawal requests are sent to the appropriate recipient thus preventing fraud.

The information received WILL NOT be shared with any other company or third party.

Username
First Name
(as shown on acct)
Last Name
(as shown on acct)
Address 1
Address 2
City
State/Provence
Country
Postal Code
(zip code)
Fax Number
(type “none” if applicable)
Home Phone Number
Work Phone Number
Fax Number
E-Mail Address
Date of Birth
(mm/dd/yyyy)
 
CREDIT CARD INFORMATION I
Type of Card
Card Number / Account Number (no dashes or spaces)
Expiration Date
Name on Credit Card
 
IF YOU ARE USING MORE THAN ONE CREDIT CARD CLICK HERE
CREDIT CARD INFORMATION II
Type of Card
Card Number / Account Number (no dashes or spaces)
Expiration Date
Name on Credit Card
 
IF YOU ARE USING MORE THAN TWO CREDIT CARDS CLICK HERE
CREDIT CARD INFORMATION III
Type of Card
Card Number / Account Number (no dashes or spaces)
Expiration Date
Name on Credit Card


I, ____________________________________, do hereby authorize NEW Bingo Billy’s authorized billing agencies, to charge my credit card(s) listed above. As authorized cardholder for the listed credit card(s) I agree to pay any and all charges associated with my personal account using the credit card(s) indicated on this document. I will take every precaution necessary to ensure the security of both my USERNAME and PASSWORD and assume full responsibility for any/all charges associated with my BingoBilly account.



_____________________
_____________________
Signature
Date


Please Complete and Fax to: 1–877–291–2424
or send scan copy to cashier@bingobilly.com


Please click the printer icon to print this page or hit 'ctrl+P'.
free bingo printer