Credit Card Authorization Form - Artist Travel Consultants

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Invoice #

Event Date *

NAME & DATE OF CONCERT

Name of MAIN CONTACT *

Name of GROUP *

Name as it appears on credit card *

Email Address

Billing Address (associated with credit card)

Street: *

Suite/Apt

City *

State *

State (Other than US or Canada)

Zip Code *

Country

Telephone Number (include area code) *

(xxx) xxx-xxxx

Email Address *

CREDIT CARD INFORMATION

Please indicate your contact at Artist Travels Consultants

Credit Card Type *

VISA

MASTERCARD

DISCOVER

AMERICAN EXPRESS

(please select one)

Card Number *

Date of Expiration *

MM/YY

Card Security Code *

TOTAL AMOUNT TO BE CHARGED *

Please note that there is a 5% credit card service fee for any partial payment via credit card.

I AUTHORIZE ATC TO CHARGE THE AMOUNT AS DESCRIBED ABOVE.

ELECTRONIC SIGNATURE *

Please initialize

DATE *

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