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OBX Dive Center Credit Card Authorization Form

This Form may be used for Charter services on the GO-BETWEEN, Guided Beach Dives, Store Rentals, and Store Merchandise Fax# 252-449-2298

Please Print or Type:

 Name: Last _______________________First _______________________MI _____      

Home Address: Street __________________________________________________

City/State _________________________________Zip Code___________________

Mailing Address___________________________________________________

_______________________________________________________________

 

Cell Phone #    ______________________Home Phone ____________________ 

Work Phone ____________________E-Mail Address ____________________________________

Birth Date: Day __________Month __________Year__________

Scuba Diving Certification Level: _________________________ Certification Agency: _________________

Where will you be staying in the Outer Banks?

Address: _______________________________________________________________

Phone Number: ____________________

 

I (print)________________________ agree by signing this form that I authorize Outer Banks Dive Center to use my credit card to reserve and pay for: rental equipment from Outer Banks Dive Center; charter space or spaces onboard the R/V GO-BETWEEN. I also understand that the cancellation policy is as follows:

• Groups of 3 or more persons cannot cancel within four weeks of the charter.

• Cancellations made seven days or more from the date of departure receive a full refund.
• Cancellations made between six days and 72 hours receive a 50% refund.
• Cancellations made less than 72 hours from departure are not refunded.
• If the trip is cancelled by the Outer Banks Dive Center you will receive a full refund

 

I authorize Outer Banks Dive Center to use the following credit card:

Card Type: (Visa, MasterCard, American Express) ________________________________

Credit card number: ______________________Credit card expiration date: ________

3 digit V code on back of card   ___ ___ ___

Name as it appears on Card: ____________________________________________________

Maximum Amount Authorized on this transaction: ___________________________________

 

Customer Signature: _________________________________________________

Printed Name: _____________________________________________________

Date of Signature: ____________________________________