Acct Type:
Visa
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: _______________________
_________________________________
_________________________________
Item(s) Description
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
Price
___________
___________
___________
___________
__________
Item #
___________
___________
___________
___________
___________
Order Total:_________________________
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