CREDIT CARD AUTHORIZATION FORM THE RK CULINARY GROUP 900 E. MARKET ST SAN ANTONIO, TX 78205 Phone: 210-225-4535 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. Please note there will be a 4% convenience fee applied to your credit card charge.
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 Address: _______________________________________________________________________________________________ Street / City / State / Zip Code Phone Number: _______________________________________________________________________________ (Including Area Code) Cardholder Signature: _______________________________________________________________________________________________ Email Address For Receipt Verification: ________________________________________________________________________________
CREDIT CARD INFORMATION: VISA _____ MASTERCARD _____ AMX _____ DISCOVER _____
Credit Card Number: _________________________________________________________________________________________________ Expiration Date: ________________ CVV@ Security Code: _____________ Amount to be charged: ______________________ (If Available) EVENT INFORMATION: Event Order # ________________ (If Available) Date of The Event: ___________________ Event Name: ___________________________ Name To Be Billed (Invoiced) ___________________________________________________________________________________________ Billing Address: _______________________________________________________________________________________________________ Street / City / State / Zip Code
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