Debit or Credit Card Authorization for Granite Hills Camp
Debit or Credit Card Authorization for Granite Hills Camp

* First Name:
* Last Name:
* Address:
* City:
* State / Province
* Zip Code:
* Phone:
* Email:

Visa or MasterCard
* Card Number
* Expiration Date
* Card Verification Number (3 digit number on back of card)
* Amount
* District Account Number
* Date of One Time Charge
Month to start automatic withdrawal
* Description of Charge (Event, Payment, or Offering)

Billing address of credit card if different from above
Street or PO Box
City, State, Zip Code

* Indicates required entry field