Cuppycake of The Month Club Order Form
Cuppycake of The Month Club Order Form
Name:_______________________________
Monthly Delivery address
__________________________________________________________________
(local address only)
Phone# ____________________________
Email Address______________________________________
Form of Payment:
Paypal or credit card____________
Subscription length 1 3 6 or 12 months _____________
Amount total to be charged:__$____________
Credit Card Payments:
Name on the Card:
Type of Card: Visa MC AmEx Discover
Other
Card Number
Expiration Date
Security Code
Billing Address
City, State, Zip