Reciprocal Authorization – Central Florida Boat Club

Name *

First

Last

the MEMBER, and undersigned, authorize CAREFREE BOAT CLUB of CENTRAL FLORIDA to debit the below listed Credit/Debit card as the apply for the following: Fuel & Oil Billing, damaged/repaired parts deemed the responsibility of the MEMBER, service fees, late fees (if applicable). I understand that if, for any reason, payment is declined and after reasonable attempts to contact MEMBER; CAREFREE BOAT CLUB reserves the right to cancel reservations, refuse boat usage until the situation is resolved, and/or request suspension the MEMBER’S club privileges.

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Card Number

Exp. Date *

Security Code

Billing Zip Code

Comment or Message *

Single Line Text

Hand to staff to review before submitting. Thank you!