Payment Authorization Request Form
Please fill out the form with your name and the details of your payment request. Include the amount you'd like to pay and where you'd like me to send the authorization link. After submitting, check the email you provided for a secure credit card authorization form. Once that is completed, I will process your payment and update the spreadsheet accordingly. You'll receive confirmation once the payment has been made.
Full Name
*
First Name
Last Name
Phone Number
Format: (000) 000-0000.
E-mail
*
example@example.com
Amount
*
Please list the amount you would like to pay here. If you are making a deposit payment, put deposit.
Message / Notes
Please include any notes about your payment - for example, which reservation or room the payment should be applied to, if you are paying for someone else in your group, or any other details.
Submit
Should be Empty: