CREDIT CARD AUTHORIZATION

I, authorize Group To Go, Inc. to charge my credit card for the amount listed below for the purpose of: *

Please list what this charge is for

Cardholders Name (as it appears on the card): *

Address

Billing Address *

City *

State *

Country

Postal code *

Card Type: *

MasterCard

VISA

Discover

AMEX

Amount *

Card Number *

CVC *

Expiration Date *

Email *

Phone

I understand that this authorization is for a one-time charge / recurring charges (select one), and that I may cancel future authorizations by submitting written notice at least three days in advance. *

one-time charge

recurring charges

Today’s Date: *