You must print this page, fill it out,
and fax it to us along with:
- a light, legible
photocopy of your Driver's License (with photo) or Passport (with
photo)
- a light, legible
photocopy of the front and back sides of the credit
card
Fax to
305-264-8078
I,
____________________________________ (cardholder's name - nombre que
esta en Tarjeta) do hereby authorize Heaven Cycle, Inc. to charge my
Visa/Mastercard/American Express/Discover
#_______________________________________________________________________
also the 3 digit security numbers on the back of the credit card
_______________.
(card number - numero te tarjeta) with the
expiration date of: ____/____ (Expiration Date - Fecha de Exp.), any
purchase made by myself or an authorized user of the above card
number above for all purchases of merchandise and freight charges
for
_______________________________________________________________________
(customer name nombre suilo), located at the following
address:
_______________________________________________________________________
Street Address
_______________________________________________________________________
City/State/Zip
_______________________________________________________________________
Country
_______________________________________________________________________
Telephone Number
_______________________________________________________________________
Fax Number
Return Policy -
Refunds within 30 days of invoice.
Poloza de devoluciones tiene
que ser acompanada con recibo en los primeros 30
dias.
________________________________________ signature
of cardholder
________________________________________ date
THIS FORM MUST BE
FILLED OUT COMPLETELY
Remember, we
need you to fax us a light, legible photocopy of yours
driver's license (with photo) or your passport (with photo) AND the
front and back of the credit card along with this completed form.
You can not e-mail this form. You must print it and fax it to
us at (1)305-264-8078.
Se necesita
copula de su tarjeta alantesy atras, copia de celula o
passports.
We apologize for any
inconvenience, but this is necessary to protect and verify all
parties involved.
Disculpa la
incovenencia esto sirbe para su protaccion y
nustra.
 | 
