CREDIT CARD AUTHORIZATION FORM THE RK CULINARY GROUP 900 E. MARKET ST SAN ANTONIO, TX 78205 Phone:210-225-4535|Fax:210-270-8260
Please fill out the following information and fax or e-mail back allowing us to process your credit card payment request. Please fill out all areas of the form. The charge will appear from The RK Culinary Group for any of the services you may receive.
I,
(client) hereby authorize The RK Culinary Group to charge my credit card as indicated on this
form and use for any outstanding balances due to the company.
CARDHOLDER INFORMATION:
Name as it appears on card:
Credit Card Stmt. Address:
Street / City / State / Zip Code
(including area code)
Phone Number:
Cardholder Signature:
Email Address for receipt verification:
CREDIT CARD INFORMATION:
MASTERCARD
AMX
DISCOVER
VISA
Credit Card Number:
Expiration Date:
CVV2 Security Code:
Amount to be charge:
EVENT INFORMATION:
Date of Event:
Event Order #
Event Name:
Location:
Name to be Billed(invoiced):
Billing Address: Street / City / State / Zip Code
125
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