Credit Card Authorization
please sign and Fax to:
 1-832-201-0957   

 

Date:--------------------------------

Name on the card:--------------------------------------------------------

Type:   visa    master card      American express

Card number # -----------------------------------------------------------

Card verification number (security code) ---------------------------------(This number is the final three digits of the number printed on the back of your card , for the American Express , it is a 4-digit number on the front of the card)

Expiration date:--------------------------------------

Total charges:-----------------------------------------

Billing address:

 

Shipping Address:

 

 

Phone: ---------------------------------------------------------------------------

Product ordered:--------------------------------------------------------------

 

Card holder signature--------------------------------------------------------

Note: To process your order, we must have your signature, card expiration date and credit card verification number, due to the nature of our service and product, all sales are final