*Please include dashes (-) in the place of spaces: ex. 1234-5678-9101-9863
Expiration DateCVN- three digits on signature line right side or four digits on front
Full PaymentDeposit or Partial Payment
I authorize BASIA, LLC. to charge my credit card for the above stated amount. In the event that my financial institution declines charges, I understand that BASIA, LLC. is not to be held responsible and does not guarantee the reservation of booth space until an alternate form of payment is given. My printed name below represents my signature.
