New Lenox Community Park District’s Camp Wewannago Financial Agreement and Credit Card Authorization Form Summer 2021Credit Card Authorization Form • April 30th, 2021
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Form • July 20th, 2022
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Form • February 5th, 2015
(NAME AS IT APPEARS ON CREDIT CARD) BY EXECUTING THIS AGREEMENT UNCONDITIONALLY AUTHORIZES KW AUTOMOTIVE TO CHARGE THE FOLLOWING CREDIT CARD:
ContractCredit Card Authorization Form • October 15th, 2013
CREDIT CARD AUTHORIZATION FORMThis booking form is the sole contract between Lion World Travel and yourself. Lion World Travel undertakes to provide the services that are detailed as per the attached invoice and you hereby agree to our standard terms and conditions.These are available on request or may be found in our brochure or on our website www.lionworldtravel.com. Your signature also means that you are duly authorised to act on behalf of and bind the other people whose names appear on this booking form. If you do not have this authority, they need to complete their own booking form.Attention: NOTE: Your airfare is subject to increase prior to the time you make full payment. However the price is not subject to increase after full payment on your air portion has been made. We strongly suggest that you pay your air portion as your deposit to avoid any increases. By signing this document, you expressly acknowledge your acceptance of this condition on your purchase. NAMES OF PASSENGERS
Credit Card Authorization FormCredit Card Authorization Form • October 8th, 2016
Per month for Conference call Services with Bow Communications. I understand that I am reserving a line and I agree not to charge back whether I actually use the line or not for each month that I am an active participant with Bow Communications. All Charges are processed in advance at the beginning of each month. To cancel service please notify in writing by the 15th of the prior month with which you want to cancel, thank you.
Tampa, FL: 2400 S. Gelman Place, Tampa, FL 33619 Ph. (813) 644-6880– Fx. (813) 644-6875Credit Card Authorization Form • December 2nd, 2016
*By inserting your legal name, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this agreement. By inserting your legal name, you consent to be legally bound by this agreement’s terms and conditions.
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Form • November 13th, 2014
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Form • March 25th, 2020
I, _______________________________, hereby agree to leave my charge card on file at Best Quality of Life, Inc., to be charged when/if I have a Broken Appointment, Session Fee and/or Bounced Check throughout the duration of treatment services with my clinician. By signing this form, you authorize, J Group Counseling Services, LLC., to charge your account for the amount checked above.
ContractCredit Card Authorization Form • February 10th, 2020
NASCAR EVENT MANAGEMENTCredit Card Authorization Form • March 21st, 2018
By signing this agreement, I acknowledge that I am authorized to sign for the card listed above and will not dispute the payment with my credit card company. By signing, I authorize NASCAR Event Management to charge this card in the amount shown on this document. This document pertains only to the payment amount indicated and in no way changes the terms of the original agreement. All amounts, refunds, returns and other terms are governed by the original agreement that this payment corresponds to.
Credit Card Authorization FormCredit Card Authorization Form • December 12th, 2017
Jacksonville, FL: 8051 Bayberry Rd., Jacksonville, FL 32256 Ph. (904) 527-3062 – Fx. (904) 527-3063Credit Card Authorization Form • December 2nd, 2016
*By inserting your legal name, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this agreement. By inserting your legal name, you consent to be legally bound by this agreement’s terms and conditions.
Sunrise, FL: 10380 NW 53rd St., Sunrise, FL 33351 Ph. (954) 726-4515– Fx. (954) 726-6021Credit Card Authorization Form • December 2nd, 2016
*By inserting your legal name, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this agreement. By inserting your legal name, you consent to be legally bound by this agreement’s terms and conditions.
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Form • July 11th, 2018
Organization Information Name: Address: Postal Code: Fax: ( ) Telephone: Bus. ( ) Res. ( ) E-mail Address: Preauthorized Credit Card Payment Card Holder's Name: Credit Card Number: ~ ~ ~ Expiry: / Type of Credit: Visa / MasterCard / Debit Agreement I understand and agree that I am authorizing the Simcoe County District School Board (SCDSB) to debit the appropriate amount from the above credit card account to cover the cost of the transcript(s) issued to the above-mentioned person. Payment for the full amount of the Transcript/s $ Signature of Authorized Cardholder Date Authorization If cardholder is different than applicant, the applicant must sign below to authorize method of payment Name Signature Date
Herman Boswell Property ManagementCredit Card Authorization Form • October 23rd, 2018
Credit Card Authorization FormCredit Card Authorization Form • May 18th, 2014
By signing this contract, I agree to the processing of my credit card for the amount of services agreed to in the Style Agreement. 50% is due upon booking and 50% is due no later than two (2) weeks prior to event. If no other form of payment has been received by the fourteenth (14) day prior to the event, I agree to the pro- cessing of this card for the remaining balance on my account.
CREDIT CARD AUTHORIZATION FORMCredit Card Authorization Form • July 19th, 2012
photocopy of a current and valid state issued driver's license or identification card before date of arrival. This agreement is VALID only with above photocopies. ATTN: All credit card info and ID info MUST BE LEGIBLE or we will not be able to honor this card for payment of the reservation. This completed form must be faxed or emailed with the supporting documents minimum 48 hrs prior to arrival for verification purposes.
Address where monthly credit card statements are received)Credit Card Authorization Form • August 22nd, 2016
Being the cardholder, by signing below I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize to charge my credit card, for the products or services provided.
