Credit Card Order Form
User Manual: Credit-Card-Order-Form
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HABEY USA INC CREDIT CARD ORDER FORM This form authorizes HABEY USA INC to charge the credit card below for purchases, freight charges, refused orders, restocking fee's, short balances. For approval, please fill out this form completely, issue a purchase order, sign and date it and fax back to: (888) 313-8698. * Custom made samples do NOT qualify for returns. All shipping charges are non-refundable. Company Information Company Name: ______________________________ Contact Name: _________________________________ Billing Address: _____________________________________________________________________________ Ship to Address (if different from Bill to):__________________________________________________________ Phone Number: _______________Extension: ______Fax Number: _____________E-mail: _________________ Product Information HABEY Sales Order Number: _______________ # Model Number Quantity PO Number: _________________ Price Extended Price 1 2 3 4 Authorized Total Total Quantity Tax Exempt: Yes, Tax ID: _______________ No Shipping Information Company Name: ______________________________ Attention Name: _________________________________ Ship to Address: ____________________________________________________________________________ Phone Number: _______________Extension: ______Fax Number: _____________E-mail: _________________ Shipping Charge: Charge My Credit Card Bill My Shipper Acc#: ____________ UPS FedEX Credit Card Information Credit Card Type: Card Number: , Name on Card: VISA MASTER AMERICAN EXPRESS Expiration Date: DISCOVER CVV Code: Phone Number: Bill to Address: Single Order — This form must be completed with each order. Please make a copy for future orders. Blanket Authorization — Authorizes to charge all orders to the referenced credit card account for future orders. I certify that I am the authorized holder and signer of the credit card reference above. I certify that all information above is complete and accurate. I hereby authorize HABEY USA to charge the credit card listed above for the collection of payment for all charges as indicated above. ______________________________________________________________________________________________________ Authorized Signature Print Name Date HABEY USA, 21015 Commerce Pointe Drive, Walnut, CA 91789, USA Tel: (909) 594-7600 Web: www.habeyusa.com 1 Where is the CVV Number? This number is printed on your MasterCard & Visa cards in the signature area of the back of the card. (it is the last 3 digits AFTER the credit card number in the signature area of the card). You can find your four-digit card verification number on the front of your American Express credit card above the credit card number on either the right or the left side of your credit card. HABEY USA, 21015 Commerce Pointe Drive, Walnut, CA 91789, USA Tel: (909) 594-7600 Web: www.habeyusa.com 2
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