(Your Name Below)

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And/Or behalf of:

Authorize Elan Caterers LLC to charge my Credit/Debit Card indicated below for *

Charge Date: On or After *

This payment is for *

Billing Street Address *

Billing City *

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Email *

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Credit/Debit Card Form

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Visa

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AMEX

Discover

Cardholder Information

Cardholder Full Name *

Card Account Number *

Expiration Date *

3 digits on back of Visa/Mastercard, 4 Digits on front of AMEX

CVV Code *

(Credit Cards are Subject to a 4% Service Charge)

E-Signature *

Signature Date *

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.