John Smith – Contract #05
Artist Name: John Smith
Card Holder Name: Jane Smith
Address:
1302 Euclid Street
Santa Monica, California 90404
Phone number: 555-555-5555
Email: test@test.com
Credit Card Type: Visa
Credit Card Number: 5555 5555 5555 5555
Expiration Date (MM/YY): 12/29
Security Code: 58
Amount
$6000
Date
December 20, 2024
Auth Code
8888
Amount
$3000
Date
December 31, 2024
Auth Code
7777
Amount
$3000
Date
January 31, 2025
Auth Code
5555
Cardholder signature:
I Hereby Authorize NYLA Talent to charge my credit card for the amount(s) listed above on the date(s) listed above. I understand there is a $25.00 fee per attempt for cards that are not approved on these dates.
Date: December 21, 2024
License Number/State: ca68454
Legal Name: Jane S. Smith
Birthdate: December 20, 2007