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  • Kokopelli CC Authorization Form

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    Pedro Sanches
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    This document is a credit card authorization form for Kokopelli Traders requesting a customer's billing information, shipping addresses, contact details, invoice or reference number, amount to be charged, credit card number, expiration date, security code, and signature. It notes that only Visa, MasterCard, and Discover are accepted and that the form will be shredded after the credit card is charged to keep the customer's data safe.

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    Kokopelli Cc Authorization Form

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    This document is a credit card authorization form for Kokopelli Traders requesting a customer's billing information, shipping addresses, contact details, invoice or reference number, amount to be charged, credit card number, expiration date, security code, and signature. It notes that only Visa, MasterCard, and Discover are accepted and that the form will be shredded after the credit card is charged to keep the customer's data safe.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    21 views1 page

    Kokopelli CC Authorization Form

    Uploaded by

    Pedro Sanches
    This document is a credit card authorization form for Kokopelli Traders requesting a customer's billing information, shipping addresses, contact details, invoice or reference number, amount to be charged, credit card number, expiration date, security code, and signature. It notes that only Visa, MasterCard, and Discover are accepted and that the form will be shredded after the credit card is charged to keep the customer's data safe.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 1

    1086 Route 100, Weston, VT 05161-5406

    PHN: 802-549-5011 FAX: 802-549-5012


    www.kokopellitraders.net email: peter@kokopellitraders.net

    CC Authorization Form
    Date: ___________________
    Name: ________________________________________________
    (as it appears on your card)

    Billing Address: ______________________________________


    City: _________________________State: ___________ ZIP: ______________
    SHIPPING TO SAME ADDRESS: yes/no
    Ship to Address: ____________________________________
    (if different than billing address)

    _________________________________________ ZIP: ______________


    Contact Phone #: ________________________________
    Invoice/Reference: ______________________________
    Amount to charge: _______________________________
    Card Number: _______________________________________________________
    (Unlike other merchants, we can figure out what type of card you are using from the
    numbers you write down. We only accept VISA/MasterCard/Discover)

    Expiration Date: __________________


    ________

    Stupid 3digit code:

    Authorized Signature: __________________________________________


    Well shred this after we use it. I know it will be a pain in the ass
    to fill one out again for a future purchase, but we want to keep your
    data safe from the prying eyes of any nefarious evildoer.

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