Please tear out along the perforations. You may make copies of this form.
If any family members wish to charge their deposit or balance of payment on a credit card, we accept VISA, MasterCard,
Discover or American Express. Below list the person wishing to charge, their credit card number, expiration date and
amount to be charged along with their signature. Please send this information along with your registration.
(One form per family group.)
CREDIT CARD TYPE:
m
VISA
m
MC
m
AMEX
m
DISC
Exp. Date: ___/___/___ Total Amount Charged: $_________________
Account Number:
nnnn nnnn nnnn nnnn
m
Deposit
or
m
Balance of Payment*
Name (Print)
Signature
(
) ( )
Billing Address*
Daytime Telephone Number
Cell Phone Number
City, State Zip
Email Address
If this credit card payment is not for your entire group, please list person(s)
and amounts to be paid with this credit card.
Person(s)
Amount
1. ________________________________________ ________________________________
2. ________________________________________ ________________________________
3. ________________________________________ ________________________________
4. ________________________________________ ________________________________
5. ________________________________________ ________________________________
6. ________________________________________ ________________________________
7. ________________________________________ ________________________________
8. ________________________________________ ________________________________
9. ________________________________________ ________________________________
10. ________________________________________ ________________________________
*Please complete this form for each charge (i.e. charge your deposit in December and then complete
another charge form in January to charge your balance). Send a separate sheet for deposit and balance
of payment.
BALANCE OF PAYMENT IS DUE
JANUARY 8, 2015.
CREDIT CARD PAYMENTS
2015 NATIONAL HIGH SCHOOL CHEERLEADING CHAMPIONSHIP
School/Team Name ______________________________ City_________________ State________
m
All-Star Resort
m
Pop Century Resort
m
Caribbean Beach Resort
m
Coronado Springs Resort
* In order for credit cards to be processed, we MUST have the billing address for the credit card being charged.
This address MUST include the zip code for the billing address.
THIS FORM MAY BE DUPLICATED.
15
