Authorize.Net State of Mind Reservation Form

Right to Charge Card

For all bridal and spa parties of two or more, or when scheduling a visit for a guest other than yourself, we ask that a credit card number be given to reserve the day. In the event that a reservation is not changed or cancelled 48 hours prior to the reservation date, State of Mind reserves the right to charge this credit card on file.
Full Name on Reservation

First Name Last Name
Reservation Date

Month Day Year

Amount of Services Scheduled

USD Description

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

By signing below, I fully understand and authorize State of Mind Salon & Day Spa to charge my credit card in the event the services are changed or canceled within 48 hours of the reservation date.
Signature

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