"Ash Scattering Services at Sea"
Big Island of Hawaii

Credit Card Authorization Form
( Please print this page and fill out the necessary information, and mail along )

 I hereby authorize "Ashes in Paradise" to charge the applicable fees ($275.00) for services requested regarding the scattering of cremains to my credit card as follows:

_______   ________   _______   _______  Expiration: ____ / _____

Name on Card: ________________________________________

Billing Address: _________________________________________

______________________________________________________

______________________________________________________

Email: _________________________

If I request any additional services besides the regular ocean scattering ( $275) I authorize those additional costs to also be charged to my credit card above.

Signature: ____________________________________________

Date: ____________

 

** any charges will show up on your credit card statement as being from "Rainbow Moon", which is the name our merchant account is under.

Mail completed form, or check to :

    Ashes in Paradise
    Attn.: Capt. Ken Arnopole
    P.O. Box 699
    Volcano, HI 96785

If you have any questions, please don't hesitate to contact us via email or call us at 808-987-0920 (USA) / 808-987-0920 (international / local).