CREDIT CARD AUTHORIZATION FORM

Caution: After you fill out this form, print, sign and submit it to Gem Faire office. If you're using a public computer, be sure to click "Clear" button when finished in order to prevent identity theft. It is also recommended that you close the browser when done.
CREDIT CARD TYPE:
VISA MASTERCARD Visa or MasterCard Only
CREDIT CARD NUMBER:
 EXP:
COMPANY NAME:
CARD HOLDER NAME:
BILLING ADDRESS:
CITY/STATE/ZIP:
PHONE:
FAX:
AMOUNT CHARGED:
 $
NOTE:
(please specify which Gem Faire location (s) & dates for this payment)

I, ___________________________________________________, authorize my credit card to be charged for the above amount. I am aware that I will receive a copy of the charge slip and that this slip will act as my record of this transaction.

Please PRINT this form, sign and submit it to Gem Faire office.
When finished, please click "Clear" button below and close browser.
Sign: _____________________________________ Date: ______________



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