University of North Alabama Career Fair
  

Charge Card Information/Authorization Form
To pay by credit card, please print, complete, and mail or fax the following form.


Name of Organization: _______________________________________________________________

Address: __________________________________________________________________________

City: __________________________________  State: _________  Zip Code: ___________________

Contact Person: ___________________________________  Phone: (_______)__________________

Name Shown on Charge Card: _________________________________________________________

Name of Event: _____________________________________________________________________

Charge Amount: $______________  Card Type: Visa ____  MasterCard ____ American Express ____

Credit Card Number: ___________________________________________  Exp. Date: ____________  Verification Code:______
                                                                                                                                                   (3 numbers on back)

Authorized Signature: ________________________________________________________________

Date Mailed or Faxed: _____________________________________

 
Mail to: UNA Career Planning and Development
UNA Box 5066
Florence, AL  35632-0001

OR

 Fax to: UNA Career Planning and Development
256-765-4169

 

 

  For UNA Career Planning and Development Office Use:

  Date Rec'd: ________________  Deposit Account #: _____________  Amount: $______________