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HOME SHOW PAYMENTS

HOME BUILDERS ASSOCIATION OF ST. LOUIS & EASTERN MO

CREDIT CARD AUTHORIZATION FORM

You can also pay online. Please visit our website at
https://www.STLHomeShow.com/HomeGarden/Credit_Card_Form.aspx. If you are unable to
pay online, please PRINT and complete this form.

Show Name: St. Louis Builders Home & Garden Show

Name on Card:

Company Name:

If different than name on credit card,
who is authorizing this payment?

Day Phone # : ( ) - Ext:

Billing Address for Credit Card (this is where the billing statement is received):
Street Address:

City, State & Zip:

Type of Card: Mastercard Visa American Express Discover

Credit Card Number:

Expiration Date: (month/year)

CSC Code: (3 or 4 digit # on back of credit card - AMEX on front of card above cc#)

Amount to charge:

Payment Type: Utilities / Directory / Passes (Please provide detail in Comment section below)

Comments
or
Special Requests:

Please note: A credit card receipt is always mailed to the credit card holder's billing address.

Signature
( (Required - will NOT be processed without signature)

The Home Builders Association of St. Louis & Eastern Missouri federal I.D. is 43-0199685. If you require a W-9 form please visit
our website at www.stlhba.com and look under the "ABOUT US" menu.