AUTHORITY TO CHARGE CREDIT CARD
PLEASE PRINT ALL OF THE REQUIRED INFORMATION BELOW
AND SIGN TO AUTHORIZE HUSHCO BUTTONS TO CHARGE YOUR CREDIT CARD
Name on card | |
Billing Address | |
Postal Zip Code Country | |
Credit card | Number
Expiration
date Type
of card
3
or 4 digit code**
** you can find the 3 or 4 digit code on the back, or front (AMEX) of your card |
SIGNATURE |
Your signature implicitly indicates that the above credit card is issued to you, and that you are the authorized user. Your signature authorizes Hushco Buttons to charge your credit card for items purchased and/or services rendered. You agree to pay the total amount according to card issuer agreement. |
WE REQUIRE YOUR ACTUAL SIGNATURE ON FILE. PLEASE PRINT THIS PAGE AFTER YOU HAVE FILLED THE BOXES, SIGN AND FAX TO 213 746 8444, OR EMAIL TO CUSTOMERSERVICE@HUSHCOBUTTONS.COM.