PLEASE COMPLETE THE FORM BELOW.

CREDIT CARDS WILL INCUR A 3% Fee

DEBITS CARDS HAVE NO FEE

Cardholder Information

(Credit Cards are Subject to a 3% Service Charge)

Signature

If you are submitting payment on behalf of someone else, we require you to upload a picture of your drivers license or Valid ID. We are not able to process payment without it.

I authorize the above named business to charge my Credit/Debit Card indicated in this authorization form according to the terms outlined above. This Payment authorization is for the event described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this Credit/Debit Card and that I will not dispute payment with my Credit Card Company or Bank, so long as the transaction corresponds to the terms indicated in this form.