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Credit Card Deposit
If You are paying your deposit with a credit card please print this page out. When it is printed please fill in the information and fax it to me. Please include a copy of the credit card, both front and back, along with your picture ID. (DRIVER’S LICENSE, MILITARY I.D.,ETC.)
LOVE PUPPIES 4 U/SHORKIE
WORLD .
CREDIT CARD AUTHORIZATION FORM
Date: ___________
I, ______________________________________, hereby expressly authorize Love Puppies 4 U , to charge my credit card in the amount of $___________ for the non refundable deposit payment on a Chihuahua puppy born on ____________ 20______ and $__________________ For the
4.0% Convenience Fee
(SAMPLE CHARGE 500.00 WOULD BE A TOTAL OF 520.00) For a total of $ ____________
Credit Card Information
Name as it appears on Credit Card: _____________________________________
Circle the type of Credit Card: Visa Mastercard
Credit Card Number: ______________________
Expiration Date: ______________ CSV#____________
Billing Address
Street: ________________________________
City: _________________________________
State: ________________________________
Zip Code: _____________________________
Phone: _______________________________
Shipping Address
Street: ________________________________
City: _________________________________
State: ________________________________
Zip Code: _____________________________
Phone: _______________________________
By executing this document, I expressly waive any right, which I may have to a refund, chargeback, or other form of return of the above charge amount. I Understand I will NOT be credited back on my Credit Card account for any reason if I cancel the sale, or are dissatisfied with purchase. I will get refund any money charged by check or store credit when proof of refund is deemed necessary. Buyer's acceptance of any animals agrees that this transaction was consummated within the state of Missouri and consents to the application of all Missouri Laws and to the jurisdiction of Missouri Courts. Should a dispute arise out of this transaction. Buyer further agrees that should he default in any obligation of this agreement, he shall be responsible for all attorney fees and court costs involved in the prosecution of this action. Acceptance constitutes An agreement to pay the above listed price and totals, with in agreed terms.
Please Note:Your credit card statement will say A Buddy for you/Hillbilly
Signature of Credit Card Holder: _____________________________________________________
Print Name _________________________________Date ___________
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