MAVERICK FOOTBALL CREDIT CARD AUTHORIZATION

Date:______________________________

Donation/Purchase Amount:___________________________________________

(There will be a 3% credit card fee added to your transaction total.)

Description of purchase/donation _________________________________________________________________________

Visa

Mastercard

AMEX

Credit Card #______________________________________________________   Exp. Date __________________________

Cardholder Name ____________________________________ Signature:__________________________________________

Parent Name (s):_______________________________________________________________________________________

Student Name (s) & Grade_______________________________________________________________________________

Billing Address:___________________________________________________City_____________________Zip___________

Home Phone_______________________________________Cell Phone___________________________________________

ALL MONIES WILL BE DEPOSITED INTO OUR FOOTBALL BOOSTER ACCOUNT VIA THE LCC FOUNDATION.

For Football Office Use Only

Amount of transaction:_______________________________Date transaction processed_____________________________

Reason for transaction:__________________________________________________________________________________

Transaction completed by:_______________________________________________________________________________

A copy of this donation form sent to football office:___________________________________Date_____________________