Credit Card Authorization Form

HOWARD   U NIVERSITY    

 

Office of Auxiliary Enterprises

Howard University

2244 10th Street NW, Suite 219

Washington, DC 20059

(202) 806-1160 (O)

(202) 234-9584 (F)

anisah.rasheed@howard.edu

auxiliary.howard.edu    

CREDIT   C ARD   A UTHORIZATION  

FOR SHORT-TERM VENDING AND LICENSING TRANSACTIONS

 

  D ATE:   _ ______________________    

CUSTOMER   N AME:   _ ______________________________________________________________________________________________________________________________    

(PRINT   N AME)  

 

BUSINESS   N AME:   _ ______________________________________________________________________________________________________________________________  

EVENT   N AME/   D ATES:   _ ________________________________________________________________________________________________________________________  

EVENT   T YPE:     P LEASE   C HECK   O NE  

☐

☐

☐

 

  S HORT-­‐TERM   V ENDING      

 

 

  A THLETICS          

 

  H OMECOMING      

☐

☐

☐

  T RADEMARK   &   L ICENSING        

 

 

  S PECIAL   E VENTS          

 

  C OMMENCEMENT      

DETAIL   D ESCRIPTION:   _ _____________________________________________________________________________________________________________  

TO   M AKE   P AYMENT   B Y   C REDIT   O R   D EBIT   C ARD,   P LEASE   C OMPLETE   T HE   F OLLOWING   I NFORMATION   A ND   E MAIL   T HIS   F ORM.

 

CARDHOLDER   N AME:   :   _ ________________________________________________________________________________________________________________________  

Exactly   A s   I t   A ppears   O n   T he   C redit/Debit   C ard   -­‐   P lease   P rint  

 

☐

☐

☐

☐

☐

 

AMEX  

 

DISCOVER  

 

MASTERCARD    

VISA  

 

DEBIT   C ARD    

 

 

 

 

(Visa   o r   M astercard   L ogo   O nly)    

CREDIT   C ARD   # :      

 

 

 

 

 

SECURITY   N UMBER  

EXP.   D ATE:    

ON   B ACK   O F   C ARD:            

 

METHOD   O F   P AYMENT

:  

 

AMOUNT:   $   _ _________________________     ADDRESS:_____________________________________________________________________________________________    

STREET,   C ITY,   S TATE,   Z IP   C ODE    

PHONE   # :   _ _____________________________________________    

 

ALTERNATIVE   # :     _ __________________________________________________  

I   a uthorize   H oward   U niversity   t o   c harge   m y   c redit/debit   c ard   f or   s ervices   r endered.     I   a gree   n ot   t o   c ontest   t his   c harge  

upon   a pproval   o f   m y   c redit.    

SIGNATURE:   _ __________________________________________________________________                   D ATE:   _ _____________________________________________________    

202-806-1361

2244 10th Street NW, Suite 219, Washington, DC 20059