Cork CC Form | Pour Masters Bartend

By providing the following information, you are authorizing Cork N Bottle the ability to charge for
services rendered. You will receive a paid invoice reflecting any charges to your card per this
agreement. The name on your credit statement will reflect, Cork N Bottle.

A fee will be assessed for credit card transactions that are “declined” or otherwise rejected. That
fee will be equal to 10% of the amount due, or $100.00, whichever is less.

It is the responsibility of The Client to ensure there are no blocks on the authorization of their credit card.

THE SIGNATURE BELOW MUST MATCH THE ACCOUNT HOLDER’S SIGNATURE ON FILE OR MUST BE

THE SIGNATURE OF ANOTHER AUTHORIZED USER ON THE ACCOUNT.

First Name

Company Name

Credit Card #

Full Name (as it appears on the card)

Security Code (3 or 4 digits)

Contact Email Address

Signature (of account holder or other user)

Last Name

Date of Event

Expiration Date

Contact Phone Number

Zip Code (Same as CC Billing Address)

Amount Authorized

I agree to pay the total amount according to card issuer agreement and terms above.

Your form has been received.
Our team will send you a confirmation of payment and receipt for your records once the transaction is complete.