SB Polo CC Auth

Santa Barbara Polo & Racquet Club

Credit Card Authorization Form
Credit Card Authorization Form
Name

*

First Name

Last Name
Email

*

[email protected]
Credit Card Type

*

VISA

Mastercard

American Express

Discover
Credit Card Number

Enter the first 12 digits, we’ll call you for the last 4
Credit Card Number

Enter the first 11 digits, we’ll call you for the last 4
Expiration Date

*
Card Identification Number

*

3 digits located on the back of the credit card
Card Identification Number

*

4 digits located on the front of the credit card
I authorize the Santa Barbara Polo & Racquet Club to use this credit card on an on-going basis for any of the following items:

Food and Beverage, Tennis/Swim/Fitness Lessons and classes, Pro Shop, Apparel and Boutique items, Facility Rental, Cabanas, Polo Boxes, Polo Gate Admission, Initiation and Membership Fees, Polo Playing Fees, Stabling, Tournament Charges, Parties and Events and other Club Charges.

I agree that I will pay for my purchases in accordance with the issuing bank cardholder agreement.
Card Holder Name

*

First Name

Last Name
Card Holder Email

*

[email protected]

Billing Address

*

GeeComp