Credit Card Authorization Form and Automatic Payment Plan

PREAUTHORIZED AUTOMATIC TRANSFER AGREEMENT: I request that Warrior Challenge Arena initiate an Automatic Funds Transfer ("automatic transfer") from the Credit Card account ("Account") that I have indicated below, for the purpose of paying deposits OR enrolling in and renewing my Ninja Warrior Class membership.

First Name *

Last Name *

Your Date of Birth *

Phone *

Email Address *

Address *

Address Line 2

City *

State *

Zip *

Credit Card Number*

Format: xxxx-xxxx-xxxx-xxxx

Expiration Date*

Format mm/yy

CVV*

Billing Zip Code*

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.

Credit Card Authorization Form and Automatic Payment Plan

Who will be participating?