My Holiday Fair Check/CC By Fax Payment Form My Holiday Fair

My Holiday Fair
Check/CC By Fax Payment Form
This form MUST be used for all Check by Fax Payments!!
Please place your check or credit card info in the space below and fax it to
My Holiday Fair Fax # 800-640-1868
▼Tape Check Here ▼
1. Fill out your check clearly and completely (payable to My Holiday Fair).
2. Tape a copy of your check to the space provided on this form.
3. Fax this form with your attached check
4. Destroy your check or keep it on file for your records. My Holiday Fair does
not need your original check. My Holiday Fair will create an ACH debit entry to
your checking account from the fax copy of your check payment. If a challenge
occurs, you will be contacted by a representative from My Holiday Fair.
5. When paying by Credit Card, a fee of 3% of the total payment is required to
process the credit card transaction.
Thank you for your payment!
Card Holder Name: __________________________________Card Type (circle one) VISA│MC│DISC│AMEX
Card #_________-_________-_________-_________ Exp Date _____-_____ Security Code _______
▲Tape Check Here ▲
or Complete Credit Card Information
Authorization Agreement for Pre-authorized Payments:
I hereby authorize My Holiday Fair to initiate an ACH debit entry to my checking account indicated and
the depository named above to debit the same to such account. I understand that My Holiday Fair will
keep a copy of my faxed check for their protection. I certify that the above information is accurate and
complete. I will not hold My Holiday Fair legally liable for any lack of correctness on my part.
Amount Authorized: $
Signature:
Name (Please Print)
/
Date:
Phone #:
(
/
)
City, ST, Zip
Name of Financial Institution: _______________________________________________________________
Routing #:
Account #:
School Name: _________________________________ School Phone: _________________________________
My Holiday Fair • 1522 Main St. Anderson, IN 46016
Phone: 877-842-0624 • Fax: 800-640-1868 • Email: [email protected]