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CREDIT
CARD AUTHORIZATION: Membership: AMOUNT ( ) $455
for 6 months ($2.49/day) $____________________
TYPE OF CARD _____________ CREDIT CARD #
________________________________ 3 NUMBERS ON BACK OF CARD
________ EXPIRATION DATE:
_____________________ FULL NAME AS
LISTED ON CARD: FIRST
____________________________ LAST
____________________________ ADDRESS CREDIT CARD BILL IS MAILED TO: ________________________________________ ________________________________ PHONE NUMBER ASSOCIATED WITH
THIS CARD _(_____)__________________________________ YOUR EMAIL ADDRESS:
________________________________________________ I hereby authorize Sierra Plan Room to charge my credit card in the sum listed above. Signature:
_____________________________________ Print name _________________________________________ *IF YOU HAVE A PAYPAL ACCOUNT, YOU CAN SEND THE PAYMENT TO sierraplanroom@yahoo.com Fill this out and fax to 702/871-8220, or email it to sierraplanroom@yahoo.com Fill out the membership application as well and get it back to us. |
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Copyright 2000 by Sierra Plan Room. All Rights Reserved. None of this website may be reproduced in any manner without prior permission of the Sierra Plan Room. All information contained in this website was obtained from sources deemed reliable. However, Sierra Plan Room assumes no responsibility for accuracy of any item herein. |