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CREDIT CARD CHARGE AND AUTHORIZATION FORM
Cardholder (Individual or Company)
Slip
Full Address
Street Address
City
State
Zip
Phone Number
Email
Services Requested
Berth Fee
Electrical Fee
Dock Locker Fee
Total Monthly Recurring Amount
AUTHORIZATION – PLEASE READ CAREFULLY
First Name
Last Name
Email
Choose how to sign
Draw
Type
I hereby authorize the City of Sacramento, Sacramento Marina Division (the Marina) to deduct payment for the services noted above from my credit card. I understand that all automatic credit card deductions are processed by a third party vendor, authorized by Chase Commerce Solutions. I accept that I will be charged the current prevailing rate for the services I requested. In order to start this monthly service, I understand that I must bring my account current. I declare the above information is true and correct and I acknowledge that it is my responsibility to notify the Marina of any changes to my services or to my credit card account. I confirm that my credit card statement will serve as my receipt for the above transaction.
disregard this