TDMA Credit Card Authorization Form

Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until canceled.

Card Type

Card Holder Full Name

Card Number

Expiration Date (mm/yy)

CVV

Zip code for Card Billing

By signing below I Authorize Two Dragons Martial Arts studio to charge my credit card above for agreed-upon purchases. I understand that my information will be saved to file for future transactions on my account.

Signature

Signature field is empty.