CREDIT CARD AUTHORIZATION

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

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: *