Authorize Payment Form
Please enter the information of the person who the dress is under
Name
First Name
Last Name
Email
example@example.com
Last 4 Digits of card being used for over the phone payment
*
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorized Amount
*
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( X )
USD
Description
Please check here
I Authorize Minervas bridal to process payment
Signature
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Comments
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