Credit Card Authorization Form | Rox Beach Weddings Ocean City Maryland

Please complete our Credit Card Authorization Form to finalize your reservation

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Cardholder Name

First

Last

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Dollar Amount to Be Charged

Multiple Choice

Visa
Master Card
Amex
Discover

Name Signature Be

Credit Card Number

Expiration Date

Security Code

Checkboxes

I Give Rox Beach, Inc permission to use this credit card for my reservation

Signature

Clear Signature

Date