Wedding booking form

Please complete the following to facilitate invoicing and payment:

  Please complete the fields below:
  Name and surname:
  Date booked:
  Person responsible for payment:
  Postal Address:
  Telephone Number:
  Fax number:
  Cell Number:
  Credit Card Details required securing balance of payment:
  Credit Card Type (Master, Visa, Diners, Amex):
  Credit Card Holder:
  Identity Number or Passport Number:
  Credit Card No:
  Last 3 digits on the back of the Card:
  Expiry Date of Credit Card:
  Should the balance of payment not be received, I hereby authorise you to debit the above credit card for the full amount due.(Yes/No answer please):

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