Credit Card RegistrationForm
Name as it appears on card:_ ____________
Credit Card Type/Account Number: NO DEBT CARDS
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