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DOWERS MUSEUM <br />Credit Card Authorization <br />Name <br />Billing Address <br />City State Zip Code <br />Contact Number ❑Cell ❑ Business ❑ Home <br />E -Mail Address <br />For the Damage Deposit, Please Use My: <br />Amex MasterCard Visa <br />Amount <br />For Payment, Please Charge My: <br />Amex MasterCard Visa <br />Amount <br />Can the same Credit Card be used for the balance due? Yes No <br />Card Number <br />Name as it appears on the card <br />Cardholder's Signature. <br />Upon Completion, Please Return This Payment To: <br />Bowers Museum <br />Special Events <br />2002 North Main Street, Santa Ana, Califomia 92706 <br />Expiration Date <br />Revised: September 4, 2013 Facility Renaod Policies & Guidelines <br />