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FTAG Recurring Payment Authorization Form
Please complete all required fields and accept the
Terms and Conditions
at the bottom of the form before submitting your recurring payment request.
Company Name
*
Card Holder's Name
*
First
Last
Address Associated with Card
*
Street Address
City
State / Province / Region
Postal / Zip Code
Credit Card Type
*
Select Card Type
MasterCard
Visa
Amex
Credit Card Number
*
CVC Code
*
Credit Card Expiration Date
*
By entering your name here, you are electronically signing this document.
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Recurring Payment Terms and Conditions
By submitting this form, you authorize Food Truck Association of Georgia to charge your card above for the agreed upon $50 per month for 12 months for a new member or $25 per month for a renewal”. You understand that your information will be saved to a file for future payments to your account. You also agree that you have the authority to make such decisions on behalf of your company.
