ONLINE PAYMENT

CREDIT CARD PAYMENT

PAY US VIA PAYPAL.

CREDIT CARD PAYMENT AGREEMENT FORM

THIS FORM IS MANDATORY FOR ALL RENTAL CUSTOMERS AND CUSTOMERS PAYING BY CHECK. THIS FORM IS REQUIRED TO

PAY FOR LOST OR DAMAGED EQUIPMENT. I AUTHORIZE CONFETTI & FOG FX TO CHARGE THE FOLLOWING CREDIT CARD

FOR THE TOTAL AMOUNT AGREED ON. ALL FIELDS ON THIS FORM ARE REQUIRED, PLEASE DO NOT LEAVE ANY
FIELDS BLANK.

CONTRACT AND BILLING INFORMATION
FIRST NAME
LAST NAME
BILLING ADDRESS:
APT OR SUITE #
CITY
ZIP CODE	(5 digits)
STATE
PHONE NUMBER
EMAIL ADDRESS
EVENT NAME
VENUE NAME & ADDRESS
EVENT START TIME
EVENT END TIME
CREDIT CARD INFORMATION
CREDIT CARD TYPE
PAYMENT AMOUNT	(USD)
CREDIT CARD NUMBER
EXPIRATION DATE (MM/YYYY)
CARD VERIFICATION NUMBER
DRIVER'S LICENSE STATE & NUMBER
OTHER
NOTES	Enter comments here!
	I AUTHORIZE CONFETTI & FOG FX SPECIAL EFFECTS COMPANY TO CHARGE THE FOLLOWING CREDIT CARD FOR THE AMOUNT STATED ON THE APPROVED PROPOSAL

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