MARKETPLACE LOC CHARM LOC CHARM LOC CHARM ORDER FORM Required information marked with *Full Name:* Email:* Phone:*Gold Charm Price: Quantity for Gold charmPlease enter a number from 0 to 10.Silver Charm Price: Quantity for Silver charmPlease enter a number from 0 to 10.Comments Total $0.00 Note: The “SUBMIT” button will appear once Total is greater than zero. Also, you will be notified when your order is in.Payment Options:* Credit Card Mail Check Credit Card American ExpressDiscoverMasterCardVisaJCBMaestroSupported Credit Cards: American Express, Discover, MasterCard, Visa, JCB, Maestro Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mail your check made payable to the Ladies of Charity. c/o Irene Reich. 3836 Meadowbrook Troy, MI 48084THANK YOU FOR YOUR SUPPORT OF THE LADIES OF CHARITY