Credit Card Authorization Form - Child Development Resource Connection Peel

Please fill out this form at least 5 days prior to the event date.

It is the Customer’s responsibility to inform CDRCP of any changes to the billing address, expiration date and/or changes to the card holder’s name of credit card account provided. Any Information provided in this form will be used for the completion of this transaction and related costs only and will be destroyed after completing the purchase.

Customer Information

basis?

Customer Name:

First

Last

Company Name:

First

Last

Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Credit Card Account | Transaction Information

Do you want to rent the room on hourly or for a full 8 hour day basis?

Hourly
Full Day

Hourly

Total

$0.00

Full Day

Payment Information

Authorization

Authorize

I hereby authorize CDRCP to process the following payment on my credit card

Date