Credit Request Form

Date:

Club Name: Club Number: - -

(begins with 53 or 63)

Club Contact: Contact Phone:

Golfers in question MUST be removed from the club’s active roster before any credit request will be considered.

Regular to Junior? Merely edit the membership type and add a birth date; do not delete.

Subject to the approval of the NCGA Membership Department

1) NCGA#: - Amount Billed: $ Credit Issued (NCGA USE ONLY): $

MEMBER’S NAME: Reason for request:

2) NCGA#: - Amount Billed: $ Credit Issued (NCGA USE ONLY): $

MEMBER’S NAME: Reason for request:

3) NCGA#: - Amount Billed: $ Credit Issued (NCGA USE ONLY): $

MEMBER’S NAME: Reason for request:

4) NCGA#: - Amount Billed: $ Credit Issued (NCGA USE ONLY): $

MEMBER’S NAME: Reason for request:

5) NCGA#: - Amount Billed: $ Credit Issued (NCGA USE ONLY): $

MEMBER’S NAME: Reason for request:

6) NCGA#: - Amount Billed: $ Credit Issued (NCGA USE ONLY): $

MEMBER’S NAME: Reason for request: