FlowerSchool Holland 2023 Credit Card Authorization Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Discover Amsterdam with FlowerSchool New York

Tuesday, April 23rd - April 29th 2023

Email *

Name on Card:

All credit cards require a 2.5% transaction fee on purchases of $600 or more.

Issuing Bank: *

Card Number: *

CVC Number *

Expiration Date: *

Billing Address: *

City: *

State/Province *

Zip/Postal Code: *

Country: *

Phone Number: *

I hereby authorize the following charges, including applicable sales tax and processing fees, to be applied to this credit card.

The first deposit of $1,000 is required no later than February 15th 2023 to hold a space on the trip (refundable until March 1st).

The second deposit of $2,000 will be due by March 1st, 2023. (non-refundable)

The remaining balance and full payment due by April 1st, 2023. (non-refundable)

First Deposit

Second Payment

Remaining Balance

Please contact if you need to pay with check

Required

Signature of Card Holder & Date

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of FlowerSchool. Report Abuse