Credit Card Charge Authorization
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By signing below, I am hereby authorizing the Company to charge my credit card for the purpose that I have checked below.
Card Type:
[__] Visa
[__] Master Card
[__] American Express
Authorized for:
[__] 70% Deposit
[__] Balance Due
[__] Entire Event
Card Number:
________________________________
Expiration Date:
____/ ____/ ______
Security Code: ______
Cardholder's Name:
________________________________
Company Name:
________________________________
Billing Address:
________________________________
City: __________ State: ___ Zip: ____
Telephone Number: ________________
_______________________ Date_____
Cardholder's Signature
FAX TO ACCOUNTING AT: (000)000-0000
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