You understand that this form represents a valid credit card authorization form in the event
of a credit card dispute for any charges made with Linda Tran. You understand that
this charge will appear on your billing statement as
.Please print and mail to:
Linda Tran
Merchandise
P.O. Box 32462
Long Beach, CA 90832-2462
Quantity |
Item
Name |
Unit
Cost |
Total
Cost |
Add
Shipping Under $50.00 |
$6.50 |
||
$50.00
- $100.00 |
$8.50 |
||
$100.00
- $200.00 |
$10.50 |
||
Over
$200.00 |
$12.50 |
||
GRAND
TOTAL |
|||
Customer Shipping Information
First Name:
Last Name:
Address:
Address (cont.):
City/Town:
State/Province:
Zip/Postal
Code:
Country:
Email:
Birthdate:
Please
make all MONEY ORDERS or CERTIFIED CHECKS payable to Linda Tran
Note: No personal checks
accepted. Payment must be made in U.S. funds drawn on a U.S. bank.
Please sign and date below to certify that you are at least eighteen (18) years of age.
Signature: ______________________________________ Date: ___________________
You
may also FAX in your order to (323) 927 1988
Please make sure your credit card information below is complete!
If your credit card is declined for any reason, you will be emailed a notification.
| Visa or MasterCard Only | |
| Full Name on Card: | |
| Credit Card Number: | |
| Expiration Date: | CVV2 Code on Back of Card: |
Customer
Billing Information
__ Check here if same as Shipping Information above
| Address: | |
| Address (cont.): | |
| City/Town: | |
| State/Province: | Zip/Postal Code: |
| Country: | |
All information
entered will be held in the strictest confidence!
You will only be billed for orders placed by you on this form.
By signing
below, you are hereby authorizing the above charges to your credit card.
You understand that this form represents a valid credit card authorization form
in the event
of a credit card dispute for any charges made with Linda Tran. You understand
that
this charge will appear on your billing statement as .
Signature: ______________________________________ Date: ___________________