Producers Guild of America East
100 Ave. of the Americas, Suite 1240, New York, NY 10013
Phone 212.894.4016, Fax 212.894.4056
[email protected]
Credit Card Authorization Form
Contact Information
Name:
Mailing address:
City, state & zip code:
Email address:
Phone number:
Invoice or event: Night of the Producer with Woody Allen – November 16, 2011
Billing Information
Cardholder’s name:
Card number:
Expiration date:
Security code:
Authorized amount: $40.00
Card type:
Billing address:
Please fax/scan & email the completed form to:
PGA East Office
Fax: 212-894-4056 Attn: Patrick Gerety
Email: [email protected]
* Please Note: The $40 credit card authorization form is a refundable deposit that will be
returned to all who attend the event. You will only be charged $40 if you are a no-show or if you
do not cancel your reservation to [email protected] at least 48 hours prior to event
start time. Your event reservation will not be confirmed until we receive your completed
authorization form.