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

Price

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Item #

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Order Total:_________________________

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