Financial Agreement with Northern Division USSA 2007-2008 travel season 

For the 2007-2008 travel season Northern Division will require a credit card number (American Express, Visa, or MasterCard only) to be used by the Northern Division Manager when payments for Northern Division projects and races are not submitted in a timely fashion.  The alternative for those who do not wish to provide this information is a $1000 deposit sent to the Northern Division Manager.

It is understood that in order for an athlete to continue to receive Northern Division support at regional events their accounts must hold a zero balance.  If payments are not made within two weeks of the close of a project/race series the Northern Division Manager will charge the credit card listed below. 

The Credit Card number will only be used by the ND manager when a check has not been received in the Northern Division offices within two weeks after the project/race series.

Credit Card Information:

Name on Card: _________________________________________

Billing Address: _________________________________________

______________________________________________________

Phone number:___________________ E-Mail: __________________

Card Number :____________________________________________

Expiration Date: _____________ Security Code (3digits): __________

With my signature I agree to pay for any unpaid race expenses if payment has not been received by Northern Division USSA two weeks after the end of the races.  By allowing the use of my credit card as provided to Northern Division above I also agree to the addition of the 4% surcharge to cover extra banking expenses incurred by Northern Division.  Once the credit card is processed for the past due amount on the account, I will receive a statement from Northern Division showing the exact amount charged to my credit card listed above.     

Signature: __________________________ Date: ________________