65% Discount For Orders Over $200 • More Discounts are Available for Volume Buyers • B to B Wholesale only

Credit Card Authorization Form

(please print this form, fill it out, and fax it to SilverForte) 

SilverForte 
640 S. Hill # 758
Los Angeles, Ca 90014
TEL 213-266-8882
FAX 213-266-8921

SilverForte 
640 S. Hill # 758
Los Angeles, Ca 90014
TEL 213-266-8882
FAX 213-266-8921

Credit Card Authorization

Date______________

Company Name___________________________________

Name As It Appears on the Card__________________________________

Cardholder's Billing Address__________________________________________________
Address
___________________________________________________
City, State and ZIP CODE

Contact Phone Number For Cardholder ____________________________

Visa/MC/Amex#_________________________________Expiration Date___________

CVV# (for VISA & M/C back of card________ CID# ( for AMEX front of card)____________

**I authorize SilverForte to charge my Visa/MC/Amex for all further purchases of merchandise shipped. 
I understand that this is your written authorization to charge these shipments to my charge cards indicated above. This agreement is valid until written notice of cancellation is received.

Cardholder's Signature X__________________________


If cardholder's billing address is outside of the US, please also provide 1) a photocopy of the front and back of the credit card, 2) a photocopy of the cardholder's passport or identification card, AND 3) the information below for the card-issuing bank. Thank you!

Name of Bank: _____________________________ Telephone No. ____________________

Address of Bank: _________________________________________________________________

To cancel the above Charge Card Authorization, please provide the information below.
This is my authorization to CANCEL the above agreement:

Company Name: _______________________

Credit Card Holder: ____________________

Date Of Cancellation: ___________________