Fax Credit Card Charge Authorization

 

Company Name:

 

Phone #:                                                                      Fax#:

 

Credit Card Type:                   Master Card          Visa                     Discover    

 

Credit Card Number:                                                             Expiration Date:

 

Name (as shown on card):

 

Billing Address (as shown on card statement):

 

___________________________________________________________________________________________

 

___________________________________________________________________________________________

 

Shipping Address (if different from billing):

____________________________________________________________________________________

 

____________________________________________________________________________________

 

I, the undersigned, do hereby authorize Marvic International, Inc. (“Mii”) to process charges against my above referenced credit card for any amount that I may owe to Mii relating to goods and/or services purchased.

 

I agree that I will not dispute any legitimate charges process by Mii against the above referenced credit card. I have read and understood the Mii terms and Conditions of Sales printed on the Mii invoice and agree that these terms shall govern my purchases from Mii. I specifically understand that goods purchased from Mii will not be returned for credit and agree not to dispute any Mii credit card charge in attempt to return goods to Mii.

 

This authorization will remain in full force and effect until terminated in writing by me.

 

Acknowledged and agreed by:

 

 

 

Text Box: For Mii internal use only     Customer Code_______________   Filed______________________

 

 


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Signature                                                               Date

 

 

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Print name