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Florida Sewing Sew-ciety

                                        Sewing . . . making a difference in all our lives

FLORIDA SEWINGSEW-CIETY

Credit Card RegistrationForm

Name as it appears on card: _________________________

Address: ______________________

Email Address: __________

Phone#: ______                               

Credit Card Type/Account Number: NO DEBITCARDS

Visa          _________________________________

MC           __________________________________

Discover  __________________________________

Amex       __________________________________

EXPIRATION DATE _ PIN# _ (3 digit on back of card)(Amex card - 4 digit # on front of card)

Only our State Treasurer, Martha Mitchell, will see this information!!!!

I authorize Florida Sewing Sew-Ciety to charge my credit card for amount of services plus a handling fee of $10.00. Include with registration form.

__________________________________

Signature 

__________________________________

Date

Mail to: Martha Mitchell, P O Box 125, Havana, Fl 32333

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