Dill & Parsley Catering Payment Authorization

CARD AUTHORIZATION FOR CATERING
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(646) 813-7966

catering@dillandparsley.com
GRAND TOTAL FROM YOUR CATERING ORDER
I HEREBY AUTHORIZE DILL & PARSLEY TO CHARGE THE CARD BELOW, FOR THE AMOUNT INDICATED. I UNDERSTAND THAT THIS IS A ONE TIME CHARGE AND WILL NOT BE SETUP AS A RECURRING PAYMENT. FOR FUTURE ORDERS AND PURCHASES DILL & PARSLEY WILL BE REQUIRED TO SEEK AUTHORIZATION AT THAT TIME.
Catering Information
Name:
Company Name:
Email
Address for reference:
Catering Date for reference:

MonthDayYear
Credit Card Information
Credit card number
Security code
Expiration date
Name on card
Billing zipcode
Should be Empty: