Client Information
Full Name

Email

Phone Number

Credit Card Authorization Form
Name on Card

Type of Card
—Please choose an option—VisaMasterCardAmerican ExpressDiscoverOther

Card Number

Expiration Date (MM/YY)

Billing ZIP Code

Amount to Be Charged

Purpose of Charge

Cardholder Phone Number

Cardholder Email

Authorization Statement:

I hereby authorize Mr. Capri to charge the credit card listed above for the amount indicated for the purpose specified. I certify that I am an authorized user of this credit card and will not dispute the payment so long as the transaction corresponds to the terms indicated on this form and in my event or catering agreement.

I agree to the authorization statement above

Typing your full name serves as a signature

Date