FRONT
Photo copy of your credit card
(Show card # and exp. date)

 

 

BACK
Photo copy of your ID Card
(Show signature)

 

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.)

  1. I here by authorized SupermodelBoutique.com to bill my credit card for my current and future orders.    Sign here:____________
  2. 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:____________
  3. Please bill me for Delivery Guarantee. If my order is lost in transit for any reason, SupermodelBoutique.com will have to either replace the order or issue me a refund immediately.   Sign here:____________
  4. 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:   __________________________________
                __________________________________
                __________________________________
                __________________________________
Authorized shipping address 1:

Name:     _____________________________
Address:  _____________________________
               _____________________________
               _____________________________
               _____________________________

 Authorized shipping address 2:

Name:     __________________________
Address:  __________________________
                __________________________
                __________________________
                __________________________

Signature: _____________________     Date:_______________________