Tampa Bay Ski Club

Printable - Credit Card Authorization Form

Mail To: Tampa Bay Ski Club 4905 West State Street, Tampa, Florida 33609
Scan or Email to: Fax: 813-289-0375 - Email: skius@skius.com
Trip Destination and Date:
Payment Method: VISA ______ MASTERCARD ______ AMERICAN EXPRESS ______ DISCOVER ______
Credit Card #: _____________________________ Expiration Date: ___________ CVV# (3-4 Digits): ______
Name on Card: ____________________________________________________________
Amount To Be Charged Today: $____________________________

Cardholder has read and agrees to the Cancellation Policy on the Tampa Bay Ski Club Trip Application.
Further, the Cardholder agrees to have the amount above charged on their credit card today.
Additional charges will require a separate authorization.

Credit Card
Billing Address:
City, State, Zip ____________________________________________________________
This verifies applicant sent applicationl on:
Date of Application: ____________________________________________________________
Cardholder Signature:
__________________________________________ Date Signed: ____________
This form must be received Via Fax (813 289-0375), Mail or Scan within 7 days of completed Application or this reservation will be cancelled. Space will not be charged or held until received.