| Rainbow Fields Credit Card | |
| Tournament or League Payment | |
| Fax to: 209-869-0400 | |
| Do not email Credit Card Information | |
| Name on Card: | |
| Coach/Player/Parent ? | |
| Team: | |
| Event: | |
| Date of Event: | |
| Billing Address: | |
| City: | |
| Zip: | |
| Phone: | |
| Amount: | |
| Visa or Master Card (only) | |
| Number: | |
| Expiration Date: | |
| Security Code: | |