Vivid Memories

Bride and groom information

Brides Name:

Grooms Name:

Wedding date:

Gift Credit - Gift Certificate information

*Gift credits will be credited to the bride and grooms account. An electronic confirmation will be
sent to the purchaser, and the bride and groom. No additional fees will apply.

*Gift Certificates can be mailed to the purchaser, or directly to the Bride and groom. An
additional fee of $4.99 will apply to the purchase for shipping and handling.

I would like to purchase:

Gift certificate

Gift credit

Please enter the gift credit/Gift certificate amount.

$

This area only needs to be complete if you are purchasing a gift certificate

Please mail the gift certificate to me.

Please mail the gift certificate to the bride.

Please mail the gift certificate to the groom.

Customer Information

Please enter your billing information as it appears on your Credit Card

*First Name:

*Last Name:

*Address Line 1:

Address Line 2:

*City:

*State:

*Zip/Postal Code:

*Phone::

*Email Address:

Payment Information

Payment Information

*Card Type:

/

*Expiration Date:

*Credit Card#:

Comments

314-920--0631

Please enter the bride and groom full name. (at least one of the two is required
so the account can be credited properly)

St. Louis, MO

314-280--1969

or