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 withinÂ 2 days the order will be cancelled.
1. A copy of the cardholderâ€™s credit card ( front only) you can white out the all the digits except the last digits
Cardholderâ€™s Name: _________________________________________________ (please print)
Billing Address: _________________________________________________________________
Telephone: __________________________________ (landline only â€“ 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 Â also enclosed a copy ofÂ the front of my credit card as well as a copy of my legal driverâ€™s license or other photo I.D. for identity verification purpose.
Signature of Cardholder: ____________________________________________________________
Fax: *ALL* required documents to: (404)768-3929