CUSTOMER CREDIT CARD AUTHORIZATION FORM I, , the ...
6513 Hollywood Blvd. Unit 206, Los Angeles CA 90028 Tel: 323.468.1174 Fax: 323.461.2662 E-mail: [email protected]
CUSTOMER CREDIT CARD AUTHORIZATION FORM I, ______________________________, the authorized cardholder hereby give full authorization to Hot Exotic Shop, Inc. to charge my credit card below for the order(s) placed by myself with your company. Billing information: Name (as it appears on the card) -----------------------------------------------------------------------------------Billing Address: ----------------------------------------------------------------------------------------------City, State, Zip -----------------------------------------------------------------------------------------------Shipping information (if different from billing) Business Name -----------------------------------------------------------------------------------------------Address --------------------------------------------------------------------------------------------------------City, State, Zip -----------------------------------------------------------------------------------------------Telephone ------------------------------------------Fax --------------------------------------------------Credit Card # --------------------------------------4/3 digit V-code -------------------------------Expiration Date ------------------------------------
Cardholder’s Signature ----------------------------------- Date ----------------------------------NOTE: IF THIS CREDIT CARD IS TO BE KEPT ON FILE AND USED FOR FUTURE ORDERS, PLEASE SIGN BELOW: Signature --------------------------------------------------- Date: ------------------------------------------Please submit order by: Fax: 323.461.2662 E-mail: [email protected] or mail to: Hot Exotic Shop 6513 Hollywood Blvd, Unit 206 Los Angeles, CA 90028
CUSTOMER CREDIT CARD AUTHORIZATION FORM I, ______________________________, the authorized cardholder hereby give full authorization to Hot Exotic Shop, Inc. to charge my credit card below for the order(s) placed by myself with your company. Billing information: Name (as it appears on the card) -----------------------------------------------------------------------------------Billing Address: ----------------------------------------------------------------------------------------------City, State, Zip -----------------------------------------------------------------------------------------------Shipping information (if different from billing) Business Name -----------------------------------------------------------------------------------------------Address --------------------------------------------------------------------------------------------------------City, State, Zip -----------------------------------------------------------------------------------------------Telephone ------------------------------------------Fax --------------------------------------------------Credit Card # --------------------------------------4/3 digit V-code -------------------------------Expiration Date ------------------------------------
Cardholder’s Signature ----------------------------------- Date ----------------------------------NOTE: IF THIS CREDIT CARD IS TO BE KEPT ON FILE AND USED FOR FUTURE ORDERS, PLEASE SIGN BELOW: Signature --------------------------------------------------- Date: ------------------------------------------Please submit order by: Fax: 323.461.2662 E-mail: [email protected] or mail to: Hot Exotic Shop 6513 Hollywood Blvd, Unit 206 Los Angeles, CA 90028
