CREDIT CARD (circle one) Visa MasterCard
AMEX Discover
Cardholders Name (as it appears on card):_______________________________
Account #: ____________________________ Exp. Date: _________
Credit Card Billing Address:( where statements are mailed )
___________________________________________________
___________________________________________________
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Mailing Address: (where you want the gift certificate sent)
___________________________________________________
___________________________________________________
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The certificate is for:_________________________________
The certificate is from:________________________________
Daytime Phone #:________________ Evening Phone #:_______________
I hereby authorize The Fresh Ketch to charge my credit card for the purchase
of gift certificate(s) for the amount of $_______________
I confirm the order described above and agree to the terms and conditions
listed in my cardholder agreement.
Name: _____________________ Signature: ___________________________ Date:__________
WE COOPERATE WITH ALL LAW AND CONSUMER PROTECTION AGENCIES TO PROSECUTE
FRAUDULENT ORDERS TO THE FULL EXTENT OF THE LAW
