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Sun | 12:00 pm – 11:30 pm |
Credit Card Authorization Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until canceled. Credit Card Information Card Type: ☐ MasterCard ☐ VISA ☐ Discover ☐ AMEX☐ Other ___________________________________________ Cardholder Name (as shown on card): ___________________________________________ Card Number: ___________________________________________ Expiration Date (mm/yy): ___________________________________________ Cardholder ZIP Code (from credit card billing address): ___________________________________________I, _______________________________, authorize __________________________________ to charge my credit card above for agreed upon purchases/services. ______________________________________________ ______________________________________________
Card Authorization Form (pdf)
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