ORDER
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Total |
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| Subtotal: |
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| (As per Imaginationperfumery.com info Page) Shipping: |
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| (Florida only) Sales Tax: |
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| Total: |
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CREDIT CARD CHARGE AUTHORIZATION
The following information is required for processing your order at Imaginationperfumery.com
Please complete the following information.
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| Card Type: |
| AmeEx |
Visa |
MasterCard |
Discover |
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| Card #: |
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| Expiration: |
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CVV: |
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Name:
(As it appears on the card) |
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Address:
(As it appears on statement) |
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Address:
(As it appears on statement) |
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| E-mail: |
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Phone: |
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I,
hereby authorize Imaginationperfumery.com to use my credit card with number mentioned above for payment on orders
of products placed with Imaginationperfumery.com. I agree to perform the obligations set forth in card member's
agreement with card issuer. I also agree to all shipping and handling charges listed above.
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| Signed by |
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Print Name |
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| Date |
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