Secure Online Payment Form
Please feel secure using our online payment form. This form is located on a secure server. The information submitted here never leaves our server, therefore your information cannot be intercepted. Your payment will be confirmed via email from accounting@holidayoc.com at the time of processing. Your credit card information will be stripped from the confirmation email for extra security. If you have any questions regarding this form or prefer to have your payment processed over the telephone please contact us at (800) 638-2102. Please DO NOT send credit card information using standard email.

Rental Information
 * Name of agreement holder:
 * Agreement number:
 * Building name: 
 * Unit number:
 * Check IN date:
 * Check OUT date:  
 * Confirmation email:     
 * Retype email:     


Billing Information
 * Card Type:
 * Name on Card:
 * Card Number:
 * Expiration Date:
 * CVV2#:  (whats this?)  
 * Amount To Charge Card:
 * Contact Phone #:
   Special
   Requests or
   Instructions:


If the cardholders name is different from the name of the agreement holder please include the cardholders billing address in this section.

(Note: an  * indicates required information.)