Credit Card and other Payment Information
Check payments: Latin Times Media, Inc., P.O. Box 18771, Tampa, Florida 33679
To Pay by e-Check: please complete check and take a picture of front and back, send it via text to (813) 407-6866 or email:
[email protected]
RSVP Vendor Type: ______________________________________ Name of Company: _________________________
Contact #: ___________________________________ Email: ______________________________________________
RSVP Sponsorship Type: ______________________________________________ (Name of Sponsorship)
____________________________________ _____________________________________ _______ _______
______
Name - As it appears on front of card
Credit Card #
Exp. Date 3 # Code Card
___________________________________
________________________________ ____________________
Billing Address: (Where statement is received) City, State Zip Code
Billing Phone #
Authorization Signature: ________________________________
Date: _____________________
e-Mail Address (Must be your official email address): ___________________________________________
By signing this form you are authorizing Publisher to debit your credit/debit card account for any and all open balances.
Balances paid by credit card are charged a processing fee of 3.80%. Your marketing services start immediately upon
processing of your payment. There are no refunds on payments or deposits on services that have already started.
Event will go on rain or shine.