Gift Certification Order Form

Recipient's Information:

First

Last

Recipient's Email

Purchaser's Information:

First

Last

Purchaser's Email:

Purchaser's Phone:

Gift Certification Value:

Personal Message:

Text area for adding a personal note (optional).

We use the latest SSL encryption to ensure your payment information is protected.

Card Type:

Cardholder's name:

CVV/CVC code:

Credit Card Number:

Expiration Date:

Billing address associated with the credit card:

Address Line 1

Address Line 2

City

State

Zip Code

Authorization for Debit/Credit Card Payment:

I authorize The Real Maids Center LLC to charge my debit/credit card for services and store my card information. This authorization is ongoing until canceled in writing. I'll notify of any changes or termination 15 days before the next billing date. If a transaction fails, I consent to two additional $35 charges within 30 days, complying with U.S. law.