Acct Type:         credit Visa     credit   Mastercard

Cardholder Name   _______________________________________________________________________________________

Credit Card Account# ___________________________________________

Expiration Date   ____/____                                CVV2 (3 digit number on back of Visa/MC)   ____________
Street Numbers of Billing Address _____________________ Zip Code of Billing Address _____________________

Salon Equipment Warehouse Fax Order Form

and Credit Card Authorization

SIGNATURE   ________________________________________________ DATE:  ______/______/______
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above.  This payment authorization is for goods/services described above, for the amount indicated above only, and is valid for one time use only.  I certify that I am the authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.
 

Name: ____________________________

Phone: ____________________________

Shipping Address: _______________________

_________________________________

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Item(s) Description

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____________________________________

____________________________________

____________________________________

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Price

___________

___________

___________

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Item #

___________

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Order Total:_________________________

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