Gift
mugs by Bitmark, Inc. Please print, sign and fax to us
here in the USA (Or use this Adobe Acrobat
pdf form which can be filled-in on your computer)
Fax
Nr.:
Today's Date:_________________________________________ My Phone Nr.: (_______) __________________________________ I, _______________________________________________________________
please print - Name of credit card owner
Credit Card Nr.
_____________________________________exp._____________
Credit Card Identification Number(Card
ID) is required for all credit card transactions.
The Card ID
is an added security feature to help protect you against online fraud.
________________________________
I
expressly authorize "Giftmugs by Bitmark, Inc." to charge my credit card
for gift mugs
I ordered, totaling up to:
US$__________________, (or the amount of the Order Confirmation)
which are to be shipped to:
City, State, Zip: ____________________________________________________
I am aware that this charge will appear on my credit card statement as:
Gift Mugs by Bitmark, Inc.
_______________________________________________________________ Signature of credit card owner.
We'll e-mail you a confirmation of your order before charging your credit card. Thank
You.
Once filled-in and signed, instead of sending it as a fax,
you can
also print, sign and then scan this page into a .jpg file and send it to
us as an
e-mail
attachment. You can also e-mail it as an Adobe Acrobat file.
