CC Auth FTT

Credit Card Authorization Form

Please complete all fields and return to Flip the Table. This information will be stored on file in the event that your rental period incurs damages or other fees. Flip the Table will never charge your card without explaining charges. You may cancel this authorization at any time by contacting us via email or in-person at 3136 W Central Ave, Toledo OH 43606. This authorization will remain in effect until canceled.

Name*

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Card Type (MasterCard, VISA, Discover, AMEX, Other)*

My Subscriptions

Monthly Membership

$15.00 for each month

Total

$0.00

Credit Card

I authorize Flip the Table to charge the above credit card for my agreed upon monthly subscription fee. Flip the Table will not charge your card without detailed explanation of charges to be made. I understand that my information will be saved on file for future agreed upon transactions to my account.

Name*

First NameLast Name

Customer Signature*

Date*

Date