Carolina Scholastic Sports Association, Inc

265 Eastchester Drive Suite 133-199, High Point, NC 27262

Phone 336-510-9962 Toll Free 888-71-USSSA

director@carolinasports.org

 

Credit Card Information

 

I have read the Terms and Conditions for Carolina Scholastic Sports Association, Inc

 

1. Cardholder Information

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* First Name:

Middle Initial:

* Last Name:

* Billing Address:

Billing Address (line2):

Billing Address (line3):

* City:

* State:

* Zip:

* Phone Number:

* Email:

 

2. Credit Card Information

 

* Card Type:

* Credit Card No:

* Expiration Date (MM/YY):

/

* Name Specified on the Credit Card:

 

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I agree to pay all Phone Orders, Email Orders, Online Orders or Face-to-Face Orders Until Written Notice Is Provided.

 

Card Holder Signature:________________________________ Date:_____________