Credit Card Authorization

First Time Using Us? Register as a Coastline Cooling customer!

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Business or Customer Name

Authorizing Individual Name

Authorizing Email Address

Authorizing Individual Phone Number

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Authorized Credit Card

Authorized Card Expiration

Authorized Security Code

A temporary hold will be placed on your card in the amount of $300, unless terms are established. I agree to pay this account in accordance to the terms established above and authorize Coastline Cooling, LLC to save my payment on file for future use. Sign me up for service! I authorize Coastline Cooling to incur up to $750 in costs per service call. If a repair involves parts, materials and labor totalling more than $750, a formal quote will have to be approved by me before incurring additional charges.

By checking this box, I acknowledge that just because my unit falls under the Manufacturer's Warranty Program, I may still be responsible for charges associated to service. I acknowledge that I will be responsible for any charges not covered by the Manufacturer's Warranty Program.

You're all set! We will be in touch asap for scheduling..