Credit Card Authorization Form Name of Child in Tennis Program* First Last Please explain the reason for submitting a new credit card authorization.*My current card was declined and I was asked by Rob Nickels Tennis Inc. to submit a new credit card on file.I have a different card that I would like to use to pay for my child's tennis classes.My card is about to expire or has expired and I am submitting a new card to be used to pay for classes.Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Address* Street Address City State / Province / Region ZIP / Postal Code Email* Upon submitting this form, your credit or debit card will be charged in the amount of 1 cent ($0.01). This is to verify that your card submission was valid.* Price: $0.01 Terms and Conditions: Please read carefully prior checking the box.* By checking the box to the left and by submitting this form, I authorize Rob Nickels Tennis Inc. to charge the above credit or debit card for future or any prior unpaid tennis services provided, including but not limited to Private Tennis Classes and Group Clinics. By clicking submit I uderstand that my credit or debit charged will be charged today in the amount of 1 cent ( $0.01)