Automatic Payment Authorization Form

Didn't get a chance to sign your autopay authorization? Complete and sign it here, it only takes a minute.

Name (as it appears on card) *

Card Type *

Card Last 4 Digits *

Card Expiration Date *

Current Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Unit Number(s) authorized for this card *

Date *

I hereby authorize the management of Powdersville Self Storage to charge my credit or debit card I have listed above for payment of my monthly storage charges, as well as any additional fees or costs that I may owe Powdersville Self Storage from time to time. This authorization remains effective regardless of whether the card is replaced (such as for loss or theft), renewed after the expiration date shown above, and/or the card number is changed by the card issuer, so long as the account with the card issuer remains active.

Electronic Signature *

Sign here

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