EmailMe Form - Land's End Credit Card Authorization

Reservation Number

Card Type: *

Please select one of the following choices.

Credit Card Number: *

Please insert your credit card number as it appears on the card.

Expiration Date: *

Please use MM/YYYY format.

Security Code: *

For American Express, this is the 4 digit number located on the front of the credit card. For Visa, Mastercard, and Discover, this is the three digit number located on the back ot the credit card.

Name As it Appears On Card: *

First Last

Billing Address: *

Street Address City State / Province / Region Postal / Zip Code Country / Region

This is the address that the credit card statements are sent to.

Authorized Amount *

$ Dollars . Cents

Phone *

### - ### - ####

Email *

Signature

Clear