Authorization for Credit Card Use

 BOBOS HAIR, INC. / www.boboshair.com  

324 S. Mountain Ave. Upland, CA 91786  Tel. 909.982.0136  Fax. 909.982.0196

PRINT AND COMPLETE THIS AUTHORIZATION AND RETURN. 
All information will remain confidential

 Name on Card:                 ___________________________________________ 

 

Billing Address:                    ___________________________________________

                                                ___________________________________________

Credit Card Type:              _____ Visa     _____ Mastercard   ____ Discover  _____ Amex

Credit Card Number:        ___________________________________________

Expiration Date:                  ___________________________________________

Card Identification Number:  ______   (last 3 digits located on the back of the credit card,)

                                                                    ______   (last 4 digits located on the front of the Amex card,)

Amount to Charge:  $  ________________ (USD) 

I authorize __BOBOS HAIR, INC.__ to charge the amount listed above to the credit card provided herein. I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.

 

Cardholder – Please Sign and Date

Signature:                             ___________________________________________

Date:                                      ___________________________________________

Print Name:                          ___________________________________________


Please fax this form to BOBOS HAIR, INC. at 1-909-982-0196  or e-mail  at boboshair@gmail.com