MAHARISHI VEDIC FOUNDATION

Maharishi Jyotish Program for Time Zone 9

Fax: (240) 290-0418

Credit Card Authorization Form

I authorize Maharishi Vedic Foundation to charge my credit card for the services listed
below:

Description of the service:

Name of participant if other than cardholder:

Name as it appears on the credit card:

3 or 4 digit CSC security code for your card:

Please check one: Visa / MC / Disc / Amex Expiration Date: ________ _______
Month Year

Credit Card # _____________ - ______________ - ______________ - ______________

Amount to be charged: $ E-mail address:

Cardholder's Signature Date

Billing Address

City State Zip Code

Home Phone Office Phone

For Maharishi Jyotish Program Office Use Only

Authorization Code: Date Entered: By:

SM
Maharishi Vedic Foundation and Maharishi Jyotish are service marks licensed to Maharishi Vedic Education Development
Corporation and used under sublicense or with permissions. 040921