RALSC Credit Card Authorization Form

By submitting this form you are authorizing The REALTORS® Association of Lake and Sumter Counties to charge your credit card.

3001 State Road 19 Tavares, FL 32778

Phone: (352) 343-3003 - Website: www.RALSC.org - E-Mail: don@ralsc.org

Fields marked with an * are required.

Contact Information

First Name *

Last Name *

Email *

Billing Information

Billing Address *

Billing City *

Billing State *

Billing Zip Code *

Card Type *

Name on Card *

Card Number *

Credit Card Expiration Date *

Security Code *

Authorization

Please type your name to authorize RALSC to charge your card *