Payment Authorization

Payment Authorization

Kauai Island Weddings 808-822-5381
Bride

First NameLast Name
Groom

First NameLast Name
Wedding Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Your email address
example: ashley@yahoo.com
Notes:
Important Payment Information

By submitting this payment, you acknowledge that it is subject to Kauai Island Weddings' Terms of Service.

Please note:

• Wedding payments are subject to our rescheduling, cancellation, and Wedding Credit policies.
• Certain Site Fees and Private Venue Reservation Fees are non-refundable.
• Please review Section 3 of our Terms of Service for complete details below.
Type of card:

Amount of your payment

USDEnter your payment amount here

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

Relation to couple
EX: Bride, or Mother of the bride etc.
Legal Signature of card holder:
Legal signature of card holder:

Legal Signature of Card Holder - Sign with finger or mouse
Should be Empty: