Watering Hole Account
Use this form to create an account at the Watering Hole! Your account will take 1-2 business days to set up. We will email you to let you know when you account is set up and ready to use!
Parent/Guardian Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Name
*
First Name
Last Name
Notes for Account (Example: no candy)
Payment Frequency (When your card will draft for the amount spent and spending limit will reset)
*
Weekly
Biweekly
First Day of the Month
Last Day of the Month
Daily
Spending Limit (Example: $20)
*
Start Date
*
-
Month
-
Day
Year
Date
Credit Card Authorization Form
Please complete all fields. You may cancel or update this authorization at any time by contacting us. This authorization will remain in effect until cancelled.
Credit Card Information
Card Type
*
Please Select
MasterCard
VISA
Discover
AMEX
Other
Cardholder Name (as shown on card)
*
Card Number (We will email you once we receive this form to ask to verify card number. Account will not be set up until card number is verified)
*
Expiration Date (mm/yy):
*
CVV Number
*
Cardholder ZIP Code (from credit card billing address):
*
I authorize "The Watering Hole at TexStar" to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.
*
I understand that if my card is declined, I will have 3 business days to update my card information and pay the account or there will be a late fee of $25 added.
*
Submit
Should be Empty: