Order
CREDIT CARD AUTHORIZATION
Please print this page, complete all of the following information and return to A White Orchid Wedding via fax at (808) 242-6853 or by mail to PO Box 2696, Wailuku HI 96793. Type or print clearly please.
Amount:_________________________ Date:_________________________
Circle One: Visa | Mastercard
Card Number:_________________________ Expiration:__________________
Name as it appears on card:_________________________________________
Billing address for this card:_________________________________________
City, State & Zip:_________________________________________________
Cardholder's area code & telephone number:___________________________
Cardholder's signature:_____________________________________________
Cardholder authorizes A White Orchid Wedding, Inc. to provide goods or services in the amount shown and agrees to perform the obligations set forth in the cardholder's agreement with the issuer.