Greetings Haslingden Bill

Account Number:
Customer Surname:
Special requests:
Amount to Pay: £

Client Information	Please Provide your Card Billing Address
(Required) Full Name (from credit card):
(Required) Address1:

(Required) Postcode:
(Required) Country:
(Required) Telephone:
(Required) E-mail address:

We accept:

                   Card Number                                Expiration Date

* Switch/Maestro Cards Only - Issue Number & Start Date

 Issue Number   Start Month and Year

Security Number (Visa/Mastercard/Switch/Solo)			*This is the last three digits located on the signature strip of the card*
Security Number *(American Express)*			*This is the four digits located on the front of the card*

You are required to submit your credit card details in the boxes above. Please note your card will not be charged until after we have confirmed your outstanding Bill amount. Confirmation of payment will be by email from us shortly after your form submission. (confirmations are sent during Greetings Haslingden Shop hours)

Submit or Reset this form

Please be patient after you click SUBMIT, it may take a short time to validate. If you click more than once it will slow down the processing of your order and may even generate a duplicate

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