2008 VRS CHARGE AUTHORIZATIONS

Download PRINTABLE PDF of VRS CHARGE AUTHORIZATIONS (2 pages / 340KB)

OVERALL CHARGE AUTHORIZATIONS

Name *
(realname field)		 Vehicle
Use this card for all charges (or indicate separate cards for each below, your choice):
Visa, MasterCard, American Express
Last 4 Digits of Card # Exp. Date
For security purposes, do not enter your entire card number. Enter the last 4 digits only. If we have your card number on file, we will process your authorization. If not, we will call to complete the authorization.
Card Billing Address
Electronic Signature
(type name)		 Date

EVENT DEPOSIT AUTHORIZATION

I, , hereby authorize you to charge my (Visa, MasterCard, American Express) card per the rates indicated on the 2008 Vintage Racing Services Inc. event schedule 60 days prior to my participation in each event I plan to attend per the terms and conditions stated.

Vehicle
Visa, MasterCard, American Express
Last 4 Digits of Card # Exp. Date
For security purposes, do not enter your entire card number. Enter the last 4 digits only. If we have your card number on file, we will process your authorization. If not, we will call to complete the authorization.
Card Billing Address
Electronic Signanture
(type name)		 Date

STORAGE DEPOSIT AUTHORIZATION

I,, hereby authorize you to charge my (Visa, MasterCard, American Express) card per the rates indicated on the 2008 Vintage Racing Services terms and conditions documents. Amount of Charge $1320.00.
Vehicle
Visa, MasterCard, American Express
Last 4 Digits of Card # Exp. Date
For security purposes, do not enter your entire card number. Enter the last 4 digits only. If we have your card number on file, we will process your authorization. If not, we will call to complete the authorization.
Card Billing Address
Electronic Signanture
(type name)		 Date

Electronic Signanture
(type name)		 Date

GENERAL INFORMATION
Address
E-Mail Address *
Telephone *

* Required


100 Lupes Drive · Stratford, CT 06615 · Tel: 203-377-7324 · Fax: 203-377-5519