Big Deluxe Credit Card Form

One Time Credit Card Payment Authorization Form

Sign and complete this form to authorize Big Deluxe Tattoo to make a one time debit to your credit card listed below. By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.
Client Name*

First NameLast Name
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area CodePhone Number
Artist Name*
Date and Time of Appointment:*

MonthDayYear
DateHourMinutesAM/PM Option
Deposits (You will be told which deposit your appointment requires.)
prevnext( X )
$60 Deposit$65.00
$60 deposit with service increase of $5 for a total of $65

$100 Deposit$107.00
$100 deposit with service increase of $7 for a total of $107

$200 Deposit$214.00
$200 deposit with service increase of $14 for a total of $214

Total $0.00
Date

MonthDayYear
Date
I, {clientName} authorize Big Deluxe Tattoo to charge my credit card account indicated below for {depositsyou} on or after {date}. This payment is for a deposit for an appointment.
The Big Deluxe Refund Policy
Signature

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One Time Credit Card Payment Authorization Form