Read CREDIT CARD CHARGE AUTHORIZATION FORM text version

CREDIT CARD CHARGE AUTHORIZATION FORM

If you wish to pay for your booth space(s) for the HOTEL, MOTEL & RESTAURANT SUPPLY SHOW OF THE SOUTHEAST via credit card, the following information must be provided. Please complete, sign and return by mail or fax to 843-626-1513. Thank you.

DATE: ___________________________

SHOW YEAR: ____________________

COMPANY NAME: ________________________________________________________ I HEREBY AUTHORIZE THE USE OF THE FOLLOWING CREDIT CARD: IN THE AMOUNT OF CARD TYPE: $___________________________________________________

VISA _______MC_________AMX_______DISCOVER__________

CARDHOLDER NAME: ____________________________________________________ CARD NUMBER: ______________________________________ EXP: __________

AUTHORIZED CARD SIGNER'S NAME: ______________________________________ *AUTHORIZED SIGNATURE: _______________________________________________

* I hereby agree to the terms set forth in Item #3 of the Exhibit Space Contract, "Payment of Spaces"

NOTE: Credit card billings will show company as Leisure Time Unlimited, Inc. Leisure Time Unlimited, Inc.

708 Main Street Myrtle Beach, SC 29577 843-448-9483 - 800-261-5991 Fax: 843-626-1513

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CREDIT CARD CHARGE AUTHORIZATION FORM

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