Credit Card Authorization Form

This form is a credit card authorization form. One payment in the amount of 1 cent ($0.01) will be debited from the submitted card upon submission of the form.

Name of Child in Tennis Program*
First Last
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Upon submitting this form, your credit or debit card will be charged in the amount of 1 cent ($0.01). This is to verify that your card submission was valid.*
Price: $0.01
Terms and Conditions: Please read carefully prior checking the box.*
- By checking the box to the left and by submitting this form, I authorize Rob Nickels Tennis Inc. to charge the above credit or debit card for future or any prior unpaid tennis services provided, including but not limited to Private Tennis Classes and Group Clinics. By clicking submit I uderstand that my credit or debit charged will be charged today in the amount of 1 cent ( $0.01)

Credit Card Authorization Form

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