DiscountBeautyDepot LLC

Credit Card Authorization Form

Print, and complete and sign the form below. Fax it with these other required documents. All request information and documentation is required or we cannot process the order. If not received within 2 days the order will be cancelled.

1. A copy of the cardholder’s credit card ( front only) you can white out the all the digits except the last digits

Cardholder’s Name: _________________________________________________ (please print)

Billing Address: _________________________________________________________________

City: __________________________________________________________________________

State________________________________ Zip__________________________________

Telephone: __________________________________ (landline only – no cellular)

Email :_____________________________________( must be your real ISP email or paid website email)

Order Number: _____________________________ Date of order: _____________________________

Total Amount of Purchased to be charged to my credit card: $_____________________________

Type of card: __________________ (Visa-Master-Discover-American Express)

Card number used to place this order: _____________________________________________________

Bank Phone Number on the back of the card: ______________________________________________

I understand these charges will appear on my credit card statement under the name of DiscountBeautyDepot.com and I accept full financial responsibility for payment of this order.

Further I  also enclosed a copy of  the front of my credit card as well as a copy of my legal driver’s license or other photo I.D. for identity verification purpose.

Signature of Cardholder: ____________________________________________________________

Email: *ALL* required documents to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Fax: *ALL* required documents to: (404)768-3929