Amitie Textiles | Update Your Details

First Name *

Last Name *

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Street Name *

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EMAIL ADDRESS *

I understand this is a 12 month program, with replacement fabric selection.*

I authorise amitie Textiles to charge my credit card monthly prior to each mail out.*

I understand amitie reserves the right to increase charges if shipping & fabric costs increase.*

Credit Card 16 digits (Master & Visa Only)*

Expiry Date (example 01/16)*

NAME ON CARD*

CARD VERIFICATION VALUE CODE (CVV) 3 numbers on back *

I am the authorised signature on this card.*

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