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NAME _____________________________________________ PHONE __________________________
ADDRESS ____________________________________________________________________________
CITY _______________________________________________ STATE ______ ZIP ________________
DESCRIPTION OF PRODUCTS OR SERVICES ______________________________________________
For your convenience you may pay with visa/master card or discover 
Card: __ __ __ __-__ __ __ __-__ __ __ __-__ __ __ __ Expiry Date __ __/__ __
Card Holder's Name _______________________________ 3 digit Security code ___ ___ ___
I hereby authorize Paragons Promotion AKA Paragon Leather to charge the amount of $ _________ to my credit card against the spaces I am renting at the motorcycle swap meet. I further understand that no spots will be held without registration form and i understand that I will not hold event promoter and/or event grounds, management and their staff responsible for any loss, damage or injury to me or my associates during the event.
Signature ____________________, Print Name _____________________ Date ___________
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