Credit Card Authorization And Consent Form printable pdf download

Credit Card Authorization And Consent Form

Credit Card Authorization and Consent Form

I, __________________________________________ hereby authorize Gelico Gymnastics to charge my credit card

for ________________________________________________________________________.

Gymnast:_________________________________________.

Total amount to be charged: $

(CAD)

Type of Card

Visa

MasterCard

Credit Card Number:

_______ 3 digit Security Code: ______

All

Expiration Date:

__________________________________________

fields

are

Name of Cardholder:

__________________________________________

mandatory

Email Address:

__________________________________________

By signing this, I acknowledge the charges described hereon and assume full responsibility for said

charges and agree to honour and abide by the terms of payment. I acknowledge and accept Gelico

Gymnastics Policies as enclosed with the Registration Package I have received.

Authorized Signature of Cardholder: _________________________________________

Date: ___________________

------------------------------------------------------------------------------------------------------------------------

Office Use:

Transaction ID:______________________________

Admin Initials: __________________________

Credit Card Authorization And Consent Form