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 USColorworks 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)
VISAMaster CardAmerican ExpressDiscover
Card Number:
Expiration Date:
Security Code:
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 USColorworks 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:
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.