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 TECHFORUM ELECTRICITY ORDER FORM FOR CONFERENCES
Electricity for Security Forum conferences costs extra (ca. $199.95) and needs to be ordered directly from Bridgewaters in advance. See below for the form, which must be printed out, filled out and faxed to Bridgewaters.
ELECTRICITY ORDER FORM FOR ELECTRICITY FOR YOUR SPONSORSHIP TABLE AT TECHFORUM’S Oct. 22nd SECURITY FORUM at BRIDGEWATERS, 11 FULTON STREET, NY NY 10038
Dear Sponsor of TechForum’s Oct. 22nd Security Forum at 11 Fulton Street in NYC:

Please complete and sign the credit card authorization letter below,
and fax it to:
ATTN: Cheryl Kahn, Bridgewaters
RE: Security Forum Oct. 18th
FAX number: 212- 608-8827
Please call me with any questions.
Sincerely,
Cheryl Kahn-Brocco ,Director of Catering, 11 Fulton Street, New York,NY 10038
P.(212) 608-7400 F.(212) 608-8827 E. ckahn@theglaziergroup.com www.theglaziergroup.com
-----------------------------------------------------------------------------------------------------------
CREDIT CARD AUTHORIZATION FOR CHARGE OF $199.95
FOR ELECTRICITY AT BRIDGEWATERS, 11 FULTON STREET, on OCT. 22nd 2008

1: TODAY’S DATE: _______________

2: YOUR NAME AND ADDRESS:
Company name: __________________________________

Contact: ______________________________________________

Street Address1: _______________________________________

Street Address 2: _______________________________________

City __________________________________________

State __________ Zip: ________________________

Phone: _______________________________________

Email: _______________________________________

3: CREDIT CARD TYPE:
American Express: _________ Mastercard: __________ Visa: ____________

Credit Card #: ___________________________________________Expiration date: _______

This fax confirms that I give my permission for Delta Dallas Alpha Corp.
(Bridgewaters) to charge the above-captioned credit card in the amount
of $199.95 towards payments-due for one (1) electrical outlet
for the Technology Managers Forum Security Forum conference
at Bridgewaters on Wed., Oct. 22, 2008

Agreed and Accepted:
Authorized Cardholder Name as Printed on Card (please print):
________________________________

Authorized Cardholder Signnature:
_________________________________________________________

 
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