Authorization del Tarjeta de Credito
You must print this page, fill it out, and fax it to us along with:
Fax to 305-264-8078
| Credit Card
Authorization Form Authorization del Tarjeta de Credito You must print this page, fill it out, and fax it to us along with:
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I, ____________________________________
(cardholder's name - nombre que esta en Tarjeta) do hereby authorize Heaven
Cycle, Inc. to charge my Visa/Mastercard/American Express/Discover
#_______________________________________________________________________
(card number - numero te tarjeta) with the expiration date of: ____/____
(Expiration Date - Fecha de Exp.), also the 3 digit security code on the back of
the credit card. ___________________(Los tres numeros de seguridad que aparece
atras de su tarjeta de creditor. )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. |
________________________________________ 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.