Loading...

I hereby authorize DEEP SOUTH STEEL dba RENT BUY BOX  to charge my credit card (provided below) for agreed upon purchases and transactions. I understand that my information will be saved to file for future transactions on my account. I understand that I may cancel this authorization in the future by contacting DEEP SOUTH STEEL dba RENT BUY BOX directly. 

First Buyer Name

First Name*

Middle Name

Last Name*

Phone*
First Buyer Date of Birth*
First Buyer Signature*
Second Buyer Name

First Name*

Middle Name

Last Name*
Second Buyer Date of Birth*
Third Buyer Name

First Name*

Middle Name

Last Name*
Third Buyer Date of Birth*
Fourth Buyer Name

First Name*

Middle Name

Last Name*
Fourth Buyer Date of Birth*
Fifth Buyer Name

First Name*

Middle Name

Last Name*
Fifth Buyer Date of Birth*
Sixth Buyer Name

First Name*

Middle Name

Last Name*
Sixth Buyer Date of Birth*
Seventh Buyer Name

First Name*

Middle Name

Last Name*
Seventh Buyer Date of Birth*
Eighth Buyer Name

First Name*

Middle Name

Last Name*
Eighth Buyer Date of Birth*
Ninth Buyer Name

First Name*

Middle Name

Last Name*
Ninth Buyer Date of Birth*
Tenth Buyer Name

First Name*

Middle Name

Last Name*
Tenth Buyer Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Credit Card Information
Card Type:*
Visa
Mastercard
Discover
American Express

Card Holder Name: *

Card Number: *

Expiration Date: (Format Example - 01/22) *

CCV : (small 3 to 4 digit number on card) *

Address Line #1 *

Address line #2

City *

State *

Zip Code *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!