Draft Change Form

DRAFT CHANGE FORM
275 Beasley Drive
Versailles, KY 40383
(859) 873-5948
www.vwcparksrec.com

MEMBER INFORMATION

Name on Account: *

First Name Last Name

Address *

Street Address

Street Address Line 2

City

Postal / Zip Code

E-mail Address *

example@example.com

Phone Number *

MEMBERSHIP & BILLING INFORMATION

Membership Type *

Payment Type *

What type of payment will you be using?

If paying by Credit or Debit card, please complete this section:

Name on Card

Card Number

Expiration Date

Date

Security Code

3 digit # on Visa/MC | 4 digit # on AMEX

If paying by Bank Draft, please complete this section:

Account Type *

What type of payment will you be using?

Name on Account

Routing Number

Account Number

By typing my name below, I acknowledge that I am authorized to change the billing information for this account and giving the Versailles-Woodford County Parks & Recreation Department permission to draft my credit/debit card or bank account for membership fees to Falling Springs Center.

Please Type Name Here *

Date

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at rjohns@vwcparksrec.com.