credit-card-authorization-form

1825 West Glenoaks Boulevard
Glendale, CA 91201
Email: orders@paradisepastry.com
Phone: 8185454000

Customer Name *

Customer Last Name

Cell Phone Number*

Email*

Type of Order*

Custom Cake

Bakery

Cafe

Website (Pickup)

Website (Delivery)

Date order was placed on*

Name on Credit Card *

Last Name on Credit Card *

Credit Card Number*

Type of Credit Card*

Visa

MasterCard

American Express

Discover

Credit Card Billing Address*

Secuirty Code (CVC)*

Expiration Month *

Expiration Year *

Amount to Charge *

I authorize Paradise Pastry and Cafe to charge my credit card for the authorized amount.

Signature *

Date of Signature*

Amount Due: $1.00