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Signature Date Name Cardmember/ Cardholder Name Lessee if different Address Apt. Zip I Cardmember/Cardholder hereby authorize 1501 Lex Owners LLC Lessor to charge the amount indicated above to the credit Card Card account above for the payment of rent and/or associated fees pursuant to the lease Rent for the apartment number and Lessee designated above. Charges Category Card CVV Code for Amex Expiration Date mm/yy Card member s Name as it appears on Card Credit Card Billing Address...

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