Order Form

These 2 Chicks Care - Order Form

Handmade with love to make a difference 💜

Customer Name:

Address:

Cell #:

Email Address:

Charity of Choice:

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Item #	Description	Price Each	Qty	Total

Subtotal:
Tax:
Grand Total:
Payment Method:

You will receive a confirmation email from These2ChicksCare@gmail.com 💜

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CUSTOMER INFORMATION
Name: ___________________________________________________________
Address: ________________________________________________________
Phone/Cell: ________________________ Email: _______________________
Charity of Choice (if applicable): _________________________________

ORDER DETAILS

Qty Item # Description Customization

___ ______ _______________________________________________________________________________ $
___ ______ __________________________________________ ______________________________________ $
___ ______ __________________________________________ ______________________________________ $
___ ______ __________________________________________ ______________________________________ $
___ ______ __________________________________________ ______________________________________ $
___ ______ __________________________________________ ______________________________________ $
___ ______ __________________________________________ ______________________________________ $

Subtotal: $_________
Tax (%): $_____
Grand Total: $_________

PAYMENT METHOD (please check one)
☐ PayPal — PayPal email: _michellelasorsa5@gmail.com_
☐ Cash — Received by: __________________________ Date: ___________
☐ Check — Check #: __________ Payable to: _______________________
☐ Credit Card — (fill cardholder name & last 4 digits below and sign authorization)

CREDIT CARD PAYMENT (customer-facing — NO full card or CVV field shown)
Cardholder name: _________________________________________________
Card type (circle): Visa / MasterCard / AmEx / Discover
Last 4 digits: ________ Billing ZIP: ________
Transaction ID (to be filled after processing): _______________________
Credit Card Authorization (signature required):
“I hereby authorize [Business Name] to charge the card for the amount of $________ for the products/services listed on this order form.”
Cardholder signature: ___________________________ Date: ___________

SPECIAL INSTRUCTIONS / NOTES:

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Signature (Customer):