Credit Card RegistrationForm
Name as it appears on card: _ _________________________
Email Address: __________
Phone#: _ _____
Card Type/Account Number: NO DEBITCARDS
EXPIRATION DATE _ PIN# _
digit on back of card)(Amex card - 4 digit # on front of card)
Only our State Treasurer, Martha Mitchell, will see
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.
Mail to: Martha
Mitchell, P O Box 125, Havana, Fl 32333