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THE GEORGIA SPORTS & EVENT MARKETING CORPORATION

Use of Credit Card Authorization
(a 5% service fee is added to all credit card purchases)

Name As It Appears on Credit Card:_____________________________________________________________

Billing Address:__________________________________________________________

              __________________________________________________________________

FedEx
Address:_____________________________________________________

____________________________________________________________

Phone Number:_____________________Email:__________________________

         Visa     MasterCard   AMEX   Discover  (please circle card used)

Credit Card Number:________________________________________________ Expiration:___________

AMEX 4 Digit Code: __________

I hereby authorize the use of the above listed credit card for all charges accrued under my Georgia Sports & Event Marketing (GSEM) account and declare that I am the owner of said card. My signature constitutes a booking agreement between The Georgia Sports & Event Marketing Corporation (GSEM) and the cardholder. I have read and agree to the GSEM Terms and Conditions and to the additional elements as stated on my invoice and / or my Contract. I also understand and agree to GSEM’s cancellation policies as outlined.

Signed:______________________________________________  Date:____________

Printed Name:________________________________________

Please fax this completed form along with a copy of the front and back of your credit card and a picture ID to 770-518-1326. Your credit card will be billed once we receive a signed invoice and / or Contract.

The Georgia Sports & Event Marketing Corporation
295 Saddlebrook Terrace
Roswell, GA 30075
Phone: 888-404-3140; 770-518-5558  Fax: 770-518-7363 
Email: jim@gsemcorp.com  Web Site: www.GsemCorp.com