JORDAN'S MODERN BRIDE AND GROOM

CREDIT CARD AUTHORIZATION FORM

 

WHAT SHOULD I DO?

q             Print form. Complete and sign form. Any questions call 803-419-4471.

q             Attach photocopy of credit card (front and back).

q             Attach copy of cardholder's driver’s license.  

q             FAX to 803-419-2404.

 

PERSONAL INFORMATION

Wedding Party Name
Your Name
Your Role
Purchase Description

 

CREDIT CARD INFORMATION

Cardholder Name (as printed on card)

Address 1

Address 2

City/State/Zip Code

Telephone

Card Type (Circle One)

Visa

MasterCard

AMEX

Discover

Card Number

Expiration Date

CID # (3 DIGIT NUMBER ON BACK)

 

AUTHORIZATION TO CHARGE CARD

 

I, ________________________________, hereby authorize JORDAN’S MODERN BRIDE AND GROOM to charge my credit card account for the following: 

 

Cost of Item (plus sales tax)      $___________

Shipping and Handling   (+)       $___________  (For Home delivery, please add $12.00 UPS Ground within the US).

Total amount to be charged       $___________

 

I understand all sales are final.  There are no refunds or exchanges.  I agree that I will pay for this purchase and indemnify and hold JORDAN’S MODERN BRIDE AND GROOM harmless, against any liability pursuant to this authorization.  I understand that my signature on this form, along with a copy of my credit card and a picture I.D., will serve as my authorized signature on the credit card charge slip.

 

 

AUTHORIZED SIGNATURE______________________________ DATE:________________