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Credit Card Form
Credit card payments incur a 3% nonrefundable convenience fee. There is no charge for payments made by personal, business or bank checks. To make a credit card payment (Visa or Mastercard), please complete this form and mail it or email ([email protected]) it to us.
Our mailing address from mid September through June 10th is Camp Lohikan, P.O. Box 189, Gladstone, NJ 07934 USA.
Our mailing address from June 11th through mid September is Camp Lohikan, 343 Wallerville Road, Lake Como, PA 18437 USA.
Camper's Name ________________________________________________________ Address _______________________________________________________________ Amount to be charged (3% will be added) ____________________________________ Please apply payment to:
__ Initial Deposit __ 2nd Payment __ Balance Payment __ Other Please specify:_______________________________________________ If the payment is being made for extra program charges (i.e., paintball, golf trip, etc.), please complete the applicable permission form.
CREDIT CARD INFORMATION
Card Holder's Name _____________________________________________________ Card Holder's Telephone/Cell Number__________________
CARD TYPE: Visa___________ Mastercard ________ Card Number ___________________________________________________________ Expiration Date (mm/yy) ______________________________ Card Holder's Signature___________________________________________________ Today's Date ________________________________
