Christmas Box - Catherines Cafe

I hereby authorize Sheer Rocks to CHARGE the card indicated in this authorization form according to the terms outlined below

Name *

First

Last

Please enter the name for the booking, if it differs from the lead card holder.*

Name (As Shown On Credit Card): *

First

Middle

Last

Is the name above the same name used to reserve your Christmas Gift Box? *

If this is a gift, please feel free to leave a message here to be added to your order.

Email *

Credit Card Type: (copy) *

Credit Card No.: *

Exp Date: *

Security Code: *

Amount XCD: *

What Are You Paying For ? *

Credit Card Image Upload - FRONT *

Click or drag a file to this area to upload.

Credit Card Image Upload - BACK *

Click or drag a file to this area to upload.

Proof of Identification (Name Must Match Credit Card) *

Click or drag a file to this area to upload.

I hereby authorize Catherines Cafe Antigua to CHARGE the card indicated in this authorization form according to the terms outlined below.