Hotel Inter-Continental Chicago

Credit Card Authorization Form

By completing this application and signing this form or using the digital signature box below, I hereby authorize MAFSI to apply charges directly to my credit card as specified below. Please type directly onto form.

Send completed form to [email protected] or fax to 888-254-0033

Company Name:

Description of Charges (Check as Applicable):

$550 - Bondurant Racing School – Saturday, January 16 – 8:00 am – 1:00 pm

Name of Cardholder:

Address of Cardholder:

Phone Number of Cardholder:

Credit Card Information

Amount Credit Card: Credit Card VISA # MasterCard Amex Exp. Date Security Code Signatur Click X to sign if electronic: Date: e: ______

MAFSI 1199 Euclid Avenue Atlanta, GA 30307 404-214-9474 – Phone 888-254-0033 – Fax [email protected] www.mafsi.org