Documents Credit Card Authorization Form

Credit Card Authorization Form

For payment of Taylor Hill Scarves & Co. products, making purchasing easier.

Date: _________________________

Registered Business Name: __________________________________________________________

(Mr/ Mrs/ Ms) (Name): ____________________________ (Last Name): _______________________

Telephone (Shop): ____________________________ Mobile: ______________________________

Email: ___________________________________________________________________________

Address: _________________________________________________________________________

Suburb: _______________________________ Postcode: ________________Vic: ______________

Card Holder Name: _______________________________________ Card Type: Business/ Personal

Card number: ______________________________________________ Expiry: _______ / ________

Credit Card type (tick):

Visa

Mastercard

Print Full Name: _______________________________ Signature: _________________________

By filing out this form I have given authorized consent to charge my credit card for my

latest order Inv. # __________. Note: Payment cannot be process till signature is provided.

_________________________________________________________________________

Please return completed form to:

Fill, scan (take a photo) and email to Taylor Hill Scarves & Co (Account Department)

Post a copy: Attn: Accounts Department Taylor Hill Scarves & Co. 408 Gore Street, Fitzroy, Vic 3065

Credit Card Authorization Form