Credit Card Authorization Form
Date_______________________________________________________________
Event/reservation name________________________________________________
Event date___________________________________________________________
Venue______________________________________________________________
Cardholder name____________________________________________________
Address____________________________________________________________
Phone number_______________________________________________________
E-mail_____________________________________________________________
Above cardholder authorizes Conner Prairie to charge the following:
- All banquet charges to the credit card
- Non-refundable deposit to the credit card for $______________
- Other (please specify)_______________________________________
Credit card to be charged:
- Visa
- MasterCard
- American Express
- Discover
Credit card number __________________________ Expiration date _________
Authorized signature _______________________________________________
As the authorized representative of this event, your signature on this agreement will confirm arrangements of the event on a definite basis. This confirms that 100% of the facility rental will be assessed in the event that cancellation occurs.
Please mail or fax a clear photocopy of both sides of the credit card along with this completed authorization form to:
Conner Prairie
Attn: Sales and Client Services
13400 Allisonville Road
Fishers, IN 46038
Fax: 317.776.6243
Phone: 317.776.6000
Thank you for choosing Conner Prairie for your event.