Facility Rental Payment

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Rental Event Contact Name

Rental Event Contact Email

Rental Date

Comments

Rental Amount

Credit Card Fee

$0.00

A 3.5% transaction service fee is applied for payments made using a credit card. To avoid this fee, please contact HD SOUTH directly to arrange for payment by cash or check.

Total

Credit Card

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name