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:
TRIP NAME / DATE:
Payment Method: VISA ______ MASTERCARD ______ AMERICAN EXPRESS ______ DISCOVER ______
Credit Card #: _____________________________ Expiration Date: ___________ CVV# (3-4 Digits): ______
Name on Card: ____________________________________________________________
(PLEASE PRINT)
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:
(Required)		 __________________________________________ Date Signed: ____________

By clicking YES, you give The Tampa Bay Ski Club the okay to Auto Charge your Final payment on same credit card.

By clicking NO, we will send you a new credit card form for you to sign. You can use the same credit card or a different credit card than original card used for your final payment.
Yes     No

We always recommend Insurance for peace of mind. If you want us to add insurance with your final payment, click YES. Preexisting conditions are not covered if insurance is paid with final payment.

If you click NO or leave it blank, we will assume insurance has been offered and you have declined our Travel Guard Trip Insurance.
Yes     No
Please email or fax this form within 7 days of completing the Trip Application to:
accounting@TampaBaySkiClub.com or Fax to (813) 289-0375.
Space will not be held until this form is received by the Tampa Bay Ski Club.