Credit Card Authorization

Customer Number:

FOR INTERNAL USE ONLY

In lieu of my credit card imprint, I,

(Name of Cardholder exactly as shown on credit card)

hereby authorize US Colorworks to charge the following orders to the card below

The current order only (form will be shredded withing 30 days of processing)

Order #

Amount: $

Future orders (this form will be kept on file)

Credit Card Information:

VISAMaster CardAmerican ExpressDiscover

Card Number:

Expiration Date:

Security Code:

Billing Address:

Address:

City / State / Zip

Phone:

E-Mail:

By signing below and submitting for payment, I acknowledge acceptance the issuers of the terms and conditions. I also agree to waive any charge-back rights. In the event of a dispute or refund request, I will contact US Colorworks directly at 888-710-0488 and will submit all order documentation in accordance with standard policy of company issuing credit card.

Signature:

(Exactly as shown on credit card)

Date:

This form must be completed in full and all information must be true and correct in order for your payment to be processed. Please email completed from to ORDERS@USCOLORWORKS.COM

FOR INTERNAL USE ONLY: INFORMATION ON THIS FORM MUST BE KEPT IN A SECURE LOCATION AT ALL TIMES. DO NOT TRANSFER OR TRANSPORT WITHOUT PRIOR AUTHORIZATION. DESTROY PROMPTLY BY SHREDDING WHEN NO LONGER NEEDED.

Credit Card Authorization

Credit Card Information:

Billing Address:

This form must be completed in full and all information must be true and correct in order for your payment to be processed. Please email completed from to ORDERS@USCOLORWORKS.COM

ORDERS@USCOLORWORKS.COM

4910 Starcrest Drive. Monroe, NC 28110 TOLL FREE 888.710.0488 LOCAL 704.288.2275 FAX 704.288.2

4910 Starcrest Drive. Monroe, NC 28110
TOLL FREE 888.710.0488
LOCAL 704.288.2275 FAX 704.288.2