I, First Name*Last Name* (name as appears on card),authorize ESCAPE FACTOR to make a one time charge to my: Please Select Visa Mastercard Discover American Express * ending in Last 4 digits of card ONLY in the amount of $Charge amount* for the reservation on Date of BOOKING*
Since I will not be present during the time of the event,the following person: First Name* Last Name* is authorized to utilize the reservation created from this card authorization.