Credit Card Payment Form
One Time Payment
Name, University, or Organization
*
Event
*
e.g.:Paradise Jam, Summer World University Games, etc.
Reason for Payment
*
This one time payment is for the above named person, university, or organization.
Payment Amount
*
Amount + 3% credit card fee
Amount Paying
Amount + 3% credit card fee
*
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( X )
USD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Email
*
example@example.com
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
By signing below I hereby authorize BTI Events to charge my credit card for the amount shown for a one time payment.
Authorization Signature
*
SUBMIT
SUBMIT
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