Payment Authorization Form Client Name * First Name Last Name Phone * (###) ### #### Email * Date of Event * MM DD YYYY Is this different from the billing name? * Yes No Name on Card * First Name Last Name Type of Card * Visa Mastercard Amex Discover credit card number * Expiration (mm/yy) * Verification # (Cvv) * Digits on back of the card Billing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Authorized Amount * USD Event ID or Invoice Number * There will be a 3.5% transaction fee added to each payment. Thank you! Thank you! We will be in touch if we have any further questions or issues.
