I Hereby authorize Wedding Concierge Services to place the charges indicated below to my credit card, to be processed without my signature, as a phone order transaction. I have read and approve of the cancellation policies which are viewable at: http://www.weddingconcierge.info/hireus.htm.

Visa: ______________________________ Exp. Date: _________________

Master Card: ______________________________ Exp. Date: _________________

American Express: ______________________________ Exp. Date: _________________

Discover: ______________________________ Exp. Date: _________________

Cardmember’s Name As Imprinted: __________________________________

Address Where Credit Card statement is Sent: _________________________

___________________________________________________

Work Phone: _________________     Home Phone: ____________________

Email Address: ________________________________________________

Cardmember's Signature: ________________________________________

Amount:  $ _________.____  (all sales final)

Date:  _________________

Wedding Concierge Services Use Only

Approval Code: _________________      Date: _______________________
Batch Number: _________________       Agent: ______________________
Amount: $_____________________

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