Amount Deposit:$__________________ Full Sale Amount: $______________________

Name as it appears on Credit Card:___________________________________________

Credit Card #:__________________________________________ Exp:_____________

Billing Address of Card Holder:

Address1:_______________________________________

Address2:_______________________________________

City, State, Zip:__________________ _______ ______________

Home Phone: (_____) _________________ Work Phone: (_____) ________________

Fax Number: (_____) _________________

I _________________________ hereby authorize Central Rent-A-Car Ltd. to charge my credit card in the full amount mentioned above, and guarantee full payment without dispute.

____________________________________________            _________________________

Signature of Card Holder                                                        DATE