Lia Avellino Payment Information form.

Submitting your payment info via this form does not charge your card, it is simply a secure way to transmit the information to me. I will use it to sign you up with Squarespace, and the charge on your card will be from Squarespace. Please do not hesitate to ask any questions :)

 

Please complete the form below

Name on card *
Name on card
Billing Address *
Billing Address