CREDIT CARD PROCESSING FORM(1)

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					                                      CREDIT CARD PROCESSING FORM
                                 Complete and Submit Form to Liz Skipper at 202-624-7891
                                               Please Print Clearly or Type




Date of Order:



Contact:

Phone Number:

Email:

                         Receipt will be provided via email



Credit Card Number:                                                        Expiration Date:


___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
                                                                           3 Digit Code:
Billing Address
Company Name:____________________________________________________________________
Street Address:_____________________________________________________________________
City, State, Zip:_____________________________________________________________________


Description of Charge:
2012 TWW Fly-In Attendee Registration for (please list name of attendee)


Amount of Sale $___50.00__________
AFWA USE ONLY


___________________________                 _____________________________
Approval Code                                Date Processed

				
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