Tampa Bay Ski Club

Printable - CREDIT CARD AUTHORIZATION


Payment Method: VISA _______ MASTERCARD _______ AMEX _______ �(NO OTHERS)
Credit Card Number: ______________________________________ Expires: ______________
Name As It Appears on Card: ____________________________________________________________
(PLEASE PRINT)
Travelers Name:
(IF DIFFERENT)
____________________________________________________________
(PLEASE PRINT)
Amount To Be Charged: $____________________________
TRIP DESTINATION / DATE: (PLEASE MAKE SELECTION)
Card holder acknowledges receipt of goods and/or services in the amount shown hereon and agrees to perform the obligations set forth in the cardholder’s agreement with card issuer. Cardholder has read and agrees to the Cancellation Policy on the Bowen Travel Trip Application. Additional charges will require a separate authorization.
Cardholder Signature: __________________________________________ Date: ____________
Cardholder Billing Address: ____________________________________________________________
City, State, Zip ____________________________________________________________
Daytime Phone: _______________________ Email Address: _______________________
This verifies information
sent via eMail on:
Date of eMail: _______________

Mail To: Tampa Bay Ski Club 4905 West State Street, Tampa, Florida 33609 or FAX to 813-289-0375