Payment Authorization Form

Payment Authorization Form

Please use this form to provide your payment information. Ensure that all mandatory fields are completed for payment processing, then click submit. If you need any assistance or have any questions, please contact our Exhibitor Services Team at events@ortizandco.com or call 407-784-2166. Thank you!
Event Name*
Booth #*
Other
Exhibitor Company Name*
Contact Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Accounting Contact Name*
Accounting Phone Number*
Please enter a valid phone number.
Credit Card Information

American Express, Visa, MasterCard and Discover
Credit Card #*
Expiration Date*
MM/YY
Security Code*
Name on Card*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature of Card Holder*

Clear
By signing the above, I acknowledge and understand that this credit card will be billed for ALL services rendered, including material handling, labor, and logistics.

For final payment, you can pay by credit card, company check (payable to Ortiz Events & Company, LLC), or via a bank wire transfer - please note that we still require the credit card authorization on file before processing any service orders. For your convenience, Ortiz&Co will use the authorization form to charge your credit card account for any additional amounts incurred due to any orders placed by your representative while on the show site. This includes material handling, labor, logistic charges for shipments received on your company’s behalf, and any unpaid balance due to Ortiz&Co.

Payments made via a credit card will incur a 4% processing fee.
Should be Empty:

Payment Authorization Form

Credit Card Information