Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Date *

MM

DD

YYYY

Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Card Type *

Visa

Master Card

Amex

Discover

Other

Name on Credit Card *

First Name

Last Name

Authorization *

By checking below and entering my full name (which serves as my legally binding signature of authorization), I authorize Mi Casa Su Casa to charge the card listed above for the following purposes: If the final venue rental payment is not made through our online invoice system within 30 days of the event. Late fees or cancellations as outlined in the Rental Agreement. Damage fees if incurred during the rental period. I understand this card will not be charged without prior notice, unless I fail to communicate or meet the agreed-upon payment deadlines. This authorization will remain in effect until my event date and any outstanding balances are resolved.

Yes, I Authorize the Above Statement.

Todays Date *

MM

DD

YYYY