Card Authorization Form

Wikiup Tennis & Swim Club – Credit Card Authorization Form

Please fill out the Credit Card Authorization Form that will be used to automatically charge for your membership.

Name(Required)

Name on card

First Last

Email(Required)

Membership Type(Required)

Tennis & Swim (Full membership)

Swim Membership only

I authorize Wikiup Tennis and Swim Club to initiate MONTHLY deductions from my account below, for my monthly dues and any charges for goods and/or services during the month.

I authorize Wikiup Tennis and Swim Club to initiate WEEKLY deductions from my account below for any goods and/or services charged during the week.

Once a month beginning the first (1st) day of:(Required)

Payment Type(Required)

Credit Card

Debit Card

Card Number(Required)

Expiration Date(Required)

Security Code (V-Code)(Required)

Zip code(Required)

Consent & E-Signature

By entering your full name and the date of completion of this form, you agree that this will serve as an electronic signature (E-Signature).

Name (E-Signature)(Required)

First Last

Date (E-Signature)(Required)