COMPANY NAME
ATTN:
ADDRESS
CITY,STATE ZIP CODE
RE: CREDIT CARD AUTHORIZATION FORM
I, ______________________ authorize ___________________ to charge my credit card in the amount of $_______ plus Tax $_______ for a grand total of $_______. The total charge of $_______ is for the purchase of _________________________________.
CREDIT CARD #______________________________________EXPIRATION_____________
Signed: _______________________ Print Name ____________________________Dated:_________
PLEASE PROVIDE THE FOLLOWING INFORMATION TO PROCESS YOUR CREDIT CARD:
BILLING ADDRESS AND ZIP CODE (WHERE STATEMENTS ARE MAILED)
BILLING ADDRESS______________________________________________
BILLING ZIP CODE_______________________________________________--
CARD CODE(THREE DIGIT NUMBER ON BACK OF VISA/MASTERCARD OR 4 DIGIT NUMBER ON THE FRONT OF AMERICAN EXPRESS CARDS___________
Copy form & fax back to us.
Security Code What's This?
The security code is a 3 or 4 digit number listed on the back of your credit card immediately following your credit card number.
This number prevents fraudulent charges to your credit card, such as someone stealing your credit card receipt and using that information to make a purchase.
We will only ship to your billing address of your credit card.
support@gametimedogsupplies.com
Our fax number 323-525-0112
WE TAKE ALL MAJOR CREDIT CARDS
Thank You for your business