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:                                                                                    __________               
 
EmailAddress:                                                                           
 
Phone#:_                                                                                     
 
 
Credit Card Type/Account Number:  NO DEBT CARDS
 
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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