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Credit Card Authorization
Credit Card Authorization
CAMPER INFORMATION
Camper Name
*
First name
Last name
Phone
*
E-mail
*
PAYMENT INFORMATION
Amount to be charged
Name on card
*
Expiration date
*
Card number
*
CVV
*
Payment consent
*
I agree to the payment terms
I authorize Camp Ak-O-Mak to use the above credit card for the amount mentioned above.
Name
*
Date
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(day / month / year)
Name
This field is for validation purposes and should be left unchanged.
