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Credit Card Authorization Form

Playground World, Inc
4400 Renaissance Parkway, Suite 3
Warrensville Hts, OH 44128
Phone: (440) 729-0909

If you intend for another individual to place orders and pay for the equipment using your credit card, you must give them authorization on this form.

Sales Rep: Customer Name:

Cardholder Information

Legal name of individual authorizing charge (If corporation, list full corporation name).

Physical Street Address (No P.O. Boxes)

City: State: Zip Code:

Phone Number: Alternate Number:

Credit Card Information

Credit Card Type: First 4 and last 4 Digits of Credit Card:

Exp Date: CVV Code:

Name, exactly as it appears on the card:

Mailing Address

Check here if mailing address is same as above

Mailing Address on File with Credit Card Company

Street Address: City: State:

Zip Code:

Authorized Users

Please list the names of those individuals that are authorized to use your credit cards as payment for merchandise. No other individuals will be allowed to request that these credit cards be used for payment.

Authorized User #1:

Authorized User #2:

Authorized User #3:

The undersigned hereby declares that the credit information listed above is true, accurate and appears in the name as stated and authorization is hereby given to the above named individuals to use these cards for purchases from Playground World, Inc.

Further, I authorize my credit card company to accept and to charge to my account for purchases initiated by the above named individuals. This authorization allows Playground World Inc. to continue to use this information and such information shall remain in full force and affect unless I revoke such authorization in writing. Playground World Inc is authorized to refund/credit account, including tax and/or other charges occurred in conjunction with purchases made with above mentioned credit cards.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

January 28, 2026 9:32 am EST

Credit Card Authorization Form Uploaded by Anthony Adamic - anthony@pgworld.com IP 99.45.129.72

January 28, 2026 2:20 pm EST

Anthony Adamic - anthony@pgworld.com added by Anthony Adamic - anthony@pgworld.com as a CC'd Recipient Ip: 99.45.129.72

January 28, 2026 3:11 pm EST

Anthony Adamic - anthony@pgworld.com added by Anthony Adamic - anthony@pgworld.com as a CC'd Recipient Ip: 99.45.129.72

January 28, 2026 3:11 pm EST

Denise Payerchin - denise@pgworld.com added by Anthony Adamic - anthony@pgworld.com as a CC'd Recipient Ip: 99.45.129.72