Four Seasons Racquet Club Credit Card Authorization Form

Name: *

Address: *

City: *

State: *

Zip Code: *

Email Address *

Home Phone: *

Cell Phone: *

Cell Phone Carrier: *

------------------------- CREDIT CARD AUTHORIZATRION ----------------------

Name as it appears on card: *

I authorize Four Seasons Racquet Club to charge the below credit card to pay for any fees incurred at the time of their occurrence.

Card Number: *

Expiration Date: *

Security Code: *

Signature: *

clear

Thank you!