Golf Simulator League

Online Credit Card Form

Sign and complete this form to authorize Tommy’s Mini Golf & Arcade to make a one-time debit to your credit card. By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.

Team name

# of Team Members

TEAM FEE: $50 per team + $20 weekly booking fee x 8 weeks

PRE-PAY AMOUNT: $210

Please complete the information below:

Credit Card Information: Account Type:

Card Holder Name

Card Number

Expiration Date

CVV2 (3-digit number on back of Visa/MC, 4 digits on AMEX):

Billing Address

City, State, Zip

Phone

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

CANCELLATION POLICY: Cancellation less than 72 hours prior to the event is non-refundable.