7007 Moeser Lane, El Cerrito, Ca 94530 510-559-7000
Automatic Credit Card Authorization
The City of El Cerrito accepts Visa and MasterCard for your convenience to pay your activity fess.
If you would like to have your payment deducted automatically from your credit card, please sign
and return this form to the City of El Cerrito Recreation Department.
I authorize the City of El Cerrito Recreation Department to automatically
deduct payment(s) from my credit card.
Please print information neatly, in blue or black ink
To be Charged (please circle one):
One Time or Monthly (start date_________________end date________________)
Activity Name or Childcare Site: __________________________ Fee:________
Home Phone:________________________ Work Phone:__________________
Credit Card Type (please circle): VISA MASTERCARD
Name as it appears on credit card:_____________________________________
Credit Card Number:________________________________________________