Pre-Authorization Form
All information will remain confidential
*
Required
Event Title
:
*
:
Event Date(s):
*
Attendee:
*
Event Contact:
*
Credit Card Holder information (PLEASE PRINT)
First Name
:
*
:
Last Name:
*
Email Address
*
:
I hereby authorize the San Diego County Office of Education to charge my credit card for the following amount(s):
Total Amount:
$
Billing address on credit card:
Address:
*
City:
*
State:
*
Zip Code:
*
:
Phone Number:
*
Note: After submitting this form you will be directed to a confidential website to fill in your credit card information
If you have any questions with completing this form, please call your event contact during normal business hours.