Waiver Processing Fee Form

Admin Fee

Payment Authorization Form
Name

First NameLast Name
Contact Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I authorize this charge as compensation for the additional administrative expenses incurred by the provider as a direct result of my failure to timely submit a full and complete liability waiver form persuant to the terms of the event ticket contract, which I read and agreed to before making my purchase. I understand that this processing fee has been earned and is not refundable for any reason.
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Admin Fee
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Waiver Admin Fee$75.00
Fee for processing a waiver that was not submitted with the correct information or was submitted after the deadline.

Quantity
Item subtotal:$0.00

Total $0.00

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Admin Fee