Icetown Fun Card Deposit

Skater's Name	*
Skater's Date of Birth	*
Phone	*
Email	*
Name That Appears on Credit Card	*
Billing Address	*
City	*
State	*
Zip	*
Credit Card Type	*	-Select One- AMEX Visa Master Card
Credit Card Number	*
Expiration Date	*
CVC Code	*
Amount	*
Special: For every $100 deposit, Icetown gives you a $15 credit! Take advantage of this offer now!
I authorize LA Kings Icetown Riverside to charge my credit card	*	Yes No
No refunds will be given on account deposits. Fund transfers between skaters must be approved by a manager/director. Account funds may not be used to pay for the following: Skating Academy monthly dues, Hockey Academy monthly dues, In-House dues, Adult League dues, or camp fees.
I understand and accept the above policies.	*	Yes No
Security Code	*