Secure Charge Card Information for Mary Jolley's Customers

Dear Buyer,

To pay with VISA, Master Card, Discover, or Discover  for your purchases from Mary Jolley, please complete and submit this form.  The charge will appear on your statement under the business name of Cat Goddess.  Thank you..
If you have any question, please email me at mj@jewelmagic.com

Data entered is encrypted by my internet secure server as indicated by your browser's secure icon (whole key for Netscape or a padlock for Explorer).

Please verify the required * fields before pressing the submit button. ++Email address must be valid in order to  receive  email confirmation from me.

Name*:
E-mail++:
Phone:
Street *
City :* State*:Zip*:
Country*

Comments, Ebay Auction # and Description

Credit Card Type:

Name On the Card
Card Number
Expiration Date (mm/yy)
*card verification number

*With most cards the 3 or 4 digits card verification number follows the card number written on the signature strip on the back of the card.
On Amex cards, the number is on the front.

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