Balmy Beach Club - Credit Card Authorization Form

Balmy Beach Club Pre-Authorized Credit Card Authorization Form

Charges Including Member Dues/Fees, F&B, Merchandise
Name*

First NameLast Name
Member Number
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
Card Type:*

VisaMastercard
If you have a credit card on file for automatic renewal, this will be the default card.

If you wish to verify the card on file, or to provide a different card, contact Tanya in the office, Monday to Friday, 9AM-5PM. It is possible to use a separate card for food & beverage.
Additional Members Authorized to Charge on This Card:
Authorized Charges*

Membership Fees (Inc. lockers, late fees, etc.)House Charges (Food & Beverage, Merchandise, Fitness Guest Fees, Section Fees)
I, {name}, authorize the Balmy Beach Club to charge my credit card on file for the above stated charges incurred at the Balmy Beach Club. I understand that this is for charges on my own account, as well as the other member(s) accounts I have listed above.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Balmy Beach Club Pre-Authorized Credit Card Authorization Form