Fillable card (MasterCard or Visa) for services. The number

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card (MasterCard or Visa) for services. The number

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The card (MasterCard or Visa) for services. The number form is 1 page long and contains:

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Country of origin: OTHERS
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I, _______________________, hereby authorize The Sensation Nation to debit my credit
card (MasterCard or Visa) for services. The number of sessions in the month will be
multiplied by program cost. The charge will occur on the 1
st
of each month and no later
than the session date.
Name on card: ___________________________________
Address of cardholder:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Credit Card # __________________________________ Security Code________
Expires________________________
Signature: ______________________________________
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card (MasterCard or Visa) for services. The number

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Completed 13 June 2022

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