Credit Card Authorization Form s4

The Copper Onion 801.355.3282 Copper Common 801.355.0543 Copper Kitchen 385.237.3159

CREDIT CARD AUTHORIZATION FORM

Date: ______

I authorize the Copper Onion Group to apply the following charges to my credit card:

Number of gift cards requested ______

Amount to charge per gift card (minimum of $10) ______Postage ($1) ______Total charge: ______

Card Type:  Amex  Visa  MC  Discover

Card Number: ______

Expiration: ____/______

Cardholder Name:______

Signature:______

form not valid without signature

Please provide a phone number in the event that we need to contact you regarding your order: (______) ______- ______

Gift certificate orders typically ship in 1-2 business days after processed. (2-4 business days during the winder holiday season.) If you have any questions please call (801) 355-3282. Thank You!