oofos credit card autho form (PDF)

CREDIT  CARD  AUTHORIZATION  
VISA  /  MASTERCARD  /  AMERICAN  EXPRESS  
 

Authorization  to  purchase  products  from  OOFOS  LLC  on  a  continuing  basis  using  the  credit  card/s  described  herein  and  the  terms  
described  below,  unless  otherwise  instructed  in  writing  by  the  credit  card  holder.  
 
TYPE  OF  CARD:                  ☐        VISA                  ☐        MASTERCARD      
☐ AMERICAN  EXPRESS  
 
Credit  Card  number______________________________________________________________Expiration  Date________________    
 
CVC  Code  (last  three  digits  on  the  back  of  the  card)  ____________________________________  
 
Cardholder  Name  (please  print):________________________________________________________________________________  
 
CREDIT  CARD  BILLING  ADDRESS  
 
 
 
REQUESTED  SHIPPING  ADDRESS  
 
Street:____________________________________  
 
Street:  ____________________________________    
 
                     ____________________________________  
 
                       ____________________________________      
   
City:        ____________________________________  
                                 City:        ____________________________________  
 
State:    __________________Zip  Code:__________    
State:    __________________Zip  Code:__________  
 
Telephone:  ________________________________                                  Telephone:  ________________________________  
 
As  the  credit  card  holder,  I  hereby  authorize  receipt  of  merchandise  at  the  shipping  address  above  
 
 
Cardholder’s  Signature________________________________________________________________________________________________  
 
 
Date_____________________________________

Cardholder   hereby   states   that   the   above   described   credit   card   is   in   his/her   name   and   that   he/she   authorizes   its   use   to   purchase  
products  from  OOFOS,  LLC  and  that  the  total  purchase  cost,  including  shipping,  will  be  priced  in  U.S.  currency.  
 
Cardholder  agrees  that  the  described  credit  card  will  not  be  charged  prior  to  the  shipment  of  any  goods.  Orders  for  sold  goods  are  to  
be   placed   by   representatives   and   employers   of   the   above-­‐described   company   via   telephone,   facsimile,   computer   transmission,   in  
writing  or  verbally  to  filed  sales  representative.  
 
Cardholder   agrees   that   all   information   provided   is   accurate   and   complete.   Cardholder   also   acknowledges   that   all   orders   may   be  
immediately   terminated   at   OOFOS’   discretion   if   any   charges   are   declined   or   charge   backs   are   claimed   against   any   outstanding  
invoiced  amount.  Disputed  to  amounts  invoiced  should  immediately  be  reported  to  orders@oofos.com.  
 
Changes  in  the  status  of  this  card  can  also  be  reported  to  orders@oofos.com.  
 
 
_______________________________________________________________________  

Cardholder  
 
 
Please  complete  all  required  information  and  fax  to  781-­‐740-­‐9650  or  e-­‐mail  to  chas@truenorthpr.com