Grandview Hall
1200 Grandview Road · (970) 555-0142 · events@grandviewhall.example
Credit card authorization form
- Event
- Whitfield and Nakamura wedding
- Date
- October 17, 2026
- Where
- Garden Room
| DepositOn signing | $800.00 |
|---|---|
| Final balance$800 at 90 days and $800 at 14 days before the event | $1,600.00 |
| Damage, up toOnly for damage to the property or its contents, within 14 days after the event, with an itemized list | $500.00 |
| Incidentals, up toOvertime at $250 an hour and extra cleaning, within 14 days after the event, with an itemized list | $750.00 |
| Most this form allows | $3,650.00 |
Authorization
I authorize Grandview Hall to charge the card below for the event named on this form: only the amounts listed above, and only when each one is due.
Damage and incidental charges are made only within 14 days after the event, never above the amounts listed, and only after Grandview Hall sends me an itemized list of what is being charged and why.
Cancellation charges follow section 5 of the venue rental agreement dated April 6, 2026.
This authorization covers only the charges on this form and ends once they are complete. I confirm that I am the cardholder, or that the cardholder has allowed me to use this card.
Card details
The cardholder fills these in by hand.
Cardholder name, as on the card
Card typeVisaMastercardAmerican ExpressDiscoverOther
Card number
Expiration date (MM/YY)
Security code (CVV)
Billing address
City, state, ZIP
Cardholder phone or email
The venue blacks out the security code as soon as the first charge is authorized and never keeps it on file.
Cardholder signature
Date
Printed name
For the venue: keeping this form
- Keep the signed form locked away, where only the people who run payments can reach it.
- Black out the security code once the first charge is authorized.
- Shred the form once the last charge on it has cleared and your processor’s dispute window has passed.
- Don’t scan, photograph, email or type the card details into anything.
This is a starting template, not legal or compliance advice. Check it with your lawyer and your card processor before you use it.
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