CREDIT CARD AUTHORIZATION
This is an authorization for Phoenix Pride to make a charge to the
below listed credit card. This is an authorized charge for all the fees
for participation as an exhibitor and/or sponsor of Phoenix Pride.
I authorize this amount to be charged to the above listed credit card.
Please fax directly to 480-247-4899 or mail to Phoenix Pride.
Name / Printed: _____________________________________
If you have any questions – email email@example.com
BUSINESS/ORGANIZATION NAME: _________________________________________
CREDIT CARD INFORMATION
Credit Card Type: _____________________________
Credit Card Number: ____________________________________
Expiration Date: ______/______
Security Code Number: ________
(listed on the back of the card—a three digit code number)
Name on the Credit Card: ___________________________________
Billing Address: __________________________________________
City / State / ZIP: _________________________________________
Amount of Charge: $______________