Seay Graphics - Credit Card Authorization Form
MUST BE COMPLETED IN FULL BY THE AUTHORIZED USER OF THE CREDIT CARD
BY EXECUTING THIS AGREEMENT I UNCONDITIONALLY AUTHORIZE SEAY GRAPHICS CUSTOM HEAT TRANSFERS TO CHARGE THE
FOLLOWING CREDIT CARD FOR SERVICES I HAVE ORDERED.
Company Name
Name as it appears on Credit Card
Credit Card Number
CVV2 Code / Security Code
Phone Number
Expiration Date
Card Type
Choose one
VISA
MasterCard
Discover
AMEX
Card Holders Billing Address
City
State
Zip / Postal Code
Province
Country
Email
Shipping Address (if different from billing address)
City
State
Zip / Postal Code
Province
Country
I CERTIFY THAT THE ABOVE STATEMENTS AND INFORMATION MADE IN THE AGREEMENT
ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO CERTIFY THAT I AM
AUTHORIZED TO EFFECT CHARGES TO THE ABOVE CREDIT CARD NUMBER