eSign Payment Form | MB Bride Payments

Orders cannot be processed until paper or electronic signatures are received. Thank you for your business!

Ticket number from receipt*

Your full name, as it appears on ticket*

Your First Your Last

Brides name*

Bride's First Bride's Last

Event date*

Email*

Phone*

I agree to pay the credit card charge below (checking means you accept)*

I Agree

Credit card charges shown on my purchase ticket*

Please input the amount of your item(s) you are purchasing

Terms of Payment*

I agree to pay this credit card charge(s) to MB Bride & Special Occasion pursuant to the credit card terms & conditions.

I Agree

eSign Information*

I agree that by checking this eSign acknowledgment checkbox and/or submitting this page of information to MB Bride & Special Occasion that I am issuing my electronic signature in acceptance to the information, transactions, terms & conditions contained within my purchase ticket available online, faxed or as email attachment and that my electronic signature is just as binding as an ink signature as allowed by the US ESign Act of 2000. Also I acknowledge that I have the option to print my current purchase ticket with its terms, sign and mail to MB Bride & Special Occasion, 123 S. Urania Avenue Greensburg, PA 15601, Attn: Customer Service instead of using my electronic signature via this form. I also understand that this electronic signature applies only to my purchase ticket transactions created up to this date & time and that I may be asked for additional signatures for any future additions to my purchase ticket. I agree that once this electronic signature is submitted that it is complete and cannot be withdrawn That I may request a single copy faxed or mailed to me by calling MB Bride & Special Occasion @ 724-836-6626 for no charge. Access to an electronic form of my ticket is available via the internet at mbbride.com MYINFO up to the event date and may be printed via any PC & printer.

I Agree

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