Credit Card Authorization Form

I hereby authorise VIP SEATS to charge my card with the amount relating to my reservation(s) outlined below.

Type of card: O  Master Card      O  Visa      O  AMEX      O  Discover

(Please circle card used)

Name as shown on my card: _____________________________________________

Card number: _____________________________________________

Expiry Date: _____________________________________________

Billing Address for the card: _____________________________________________

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     O  US Resident:      O  Non- US Resident:

Security code:

This will be a 3 digit code for Mastercard and Visa (see reverse of card)

and a 4 digit code for AMEX (located on front of card.): _________

The amount of $__________ USD which is due to VIP SEATS will be charged to the above mentioned card for

     O  Super Bowl Tickets      O  Super Bowl Packages

Purchase Details: _____________________________________________

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Signature as per card: _____________________________________________

Name: _____________________________________________

Date: _____________________________________________