Credit Card Authorization Form

CREDIT CARD AUTHORIZATION FORM

Team/ Club Name:

Hotel Rooms Reserved at Green Valley Ranch

$189 (Wed-Sun Rate) + $20 (Resort Fee) x 12% (Tax)= $234.08 total per night

Amount Authorized to Charge: Stay for Play Minimum Room Night Requirement of 10 total room nights @ Reserved Hotel or Rate per room night (pre tax/resort fee) for 1st Nights Stay; whichever is greater

Cardholder Name (please print):

Cardholder Billing Address:

City: State: Zip Code:

Phone Number:

Card Number:

Exp. Date (mm/yy): Security Code Number:

(This number is 3 digits & is the non-embossed number printed on the signature panel on the back of your card immediately following the card acct number. This number is recorded as an additional security precaution.)

Type of Card: □ VISA □ MASTERCARD □ AMERICAN EXPRESS □ DISCOVER

Additional Information:

By checking the box, I acknowledge that I am the responsible party for the Soccer Team listed above and that I am making hotel reservations for and will be responsible for informing the team and players of the process and deadlines for any changes, no shows or cancellations to the rooming list that I am submitting with this form. Changes and Cancellations MUST be submitted in writing to before Tuesday, September 30, 2016 to avoid any penalties from the Tournament

By checking the box, I authorize Nevada Junior Cup Tournament (c/o Eventure, LLC, DBA Sports Tournament Concierge) to charge the credit or debit card information provide on this credit card authorization form for cancellations or if any parties on the rooming list no-show any or all portions of the reserved rooms after the 30-day cancellation group reservation deadline based on the rooming list submitted. I understand the card will be charged one nights' room and tax if the hotel guests on my team have not provided Eventure or the hotel with their credit card information.

Cardholder Signature:Date:

E-Mail form or call (702) 202-2107 with any questions.