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: _______________ PO Number: _________________
# Model Number Quantity Price Extended Price
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2
3
4
Authorized Total
Total Quantity
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: VISA MASTER AMERICAN EXPRESS
Card
Num,ber:
Expiration Date: CVV Code:
Name on Card: 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
DISCOVER
HABEY USA, 21015 Commerce Pointe Drive, Walnut, CA 91789, USA Tel: (909) 594-7600 Web: www.habeyusa.com
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Tax Exempt:
No
Yes, Tax ID:
_______________
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
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