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FRONT
Photo copy of your credit card
(Show card # and exp. date)
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BACK
Photo copy of your credit card
(Show signature)
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I hereby certify
that I am an adult of legal age in my Country/State/Community and
I am the legal owner of the above credit card. I accept the
following terms that I sign: (Please strike out
the terms that you do not agree to.)
- I here by
authorized SupermodelBoutique.com/Tricon Interactive, Inc. to bill my credit card for
my current and future orders.
Sign here:____________
- I don't need
Delivery Guarantee. I will pay for the order in the event that
it is damaged, lost, or confiscated by my local customs due to
my country's import compliance. I will file an insurance claim
with the shipping carrier directly if my order is lost or damaged
during shipping.
Sign here:____________
- Please bill
me for Delivery Guarantee. If my order is lost in transit for
any reason, SupermodelBoutique.com/Tricon Interactive, Inc. will have to either replace
the order or issue me a refund immediately.
Sign here:____________
- Please ship
my order in the original manufacturer packaging.
I fully understand my country's import compliance, rules and regulations.
I will pay for the order if it is confiscated by my local customs.
Sign here:____________
Card Number: ______________________________
Expiration Date: ______________
| Name
& billing address as shown on credit card statement:
Name:
__________________________________
Address: __________________________________
__________________________________
__________________________________
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| Authorized
shipping address 1: Name:
_____________________________
Address: _____________________________
_____________________________
_____________________________
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Authorized
shipping address 2: Name:
__________________________
Address: __________________________
__________________________
__________________________
__________________________ |
Signature: _____________________
Date:_______________________ |