You can print out this fax order form for a secure way to send your credit card details.  
Credit Card Information Fax Form

Garden House Gallery
1953 Victoria Rd. S.
Guelph, Ontario
Tel: 519-822-6275 Fax: 519-822-2382
Please print this form, fill it out completely, and fax it to the fax number above.
VIA MaryDawnRoberts.com

 

Title Size Price Total
       
       
       
       
 G.S.T. (7%)     
 P.S.T. (8%)     
 Total     
 
Cardholder's Name : _______________________________________________
(as it appears on card)
Card Number : __________________________________
Expiration date : ____________________
(Visa)
 
(MasterCard)
 
(AMEX)
 
card.
I hereby authorize a charge of ____________ CAD Total Amount
Cardholder's Address : _____________________________________________
_________________________________________________________________
_________________________________________________________________
E-Mail Address ( Request ) : _____________________________________
Tel  : (          ) _________________________________
Fax : (          ) _________________________________
Signature : ____________________________ Date :         /          /
(as it appears on card)