125 Main Street, Netcong, NJ 07857

TEL – 973.448.1766

C R E D I T   C A R D   P A Y M E N T   A U T H O R I Z A T I O N   F O R M

PLEASE PRINT THIS FORM, COMPLETE ALL INFORMATION AND SIGN!

FAX TO: 973.448.1795

Item No:______________________ Quantity: _____________ Color:______________

Imprint Color: _________________ Date Needed: _____________________________

Item Description: _______________________________________________________

Contact Name: _________________________________________________________

Phone Number: _______________________ Fax: _____________________________

Email Address: _________________________________________________________

NAME (As it appears on card): __________________________ EXP. DATE_______

CREDIT CARD NUMBER : _____________________________________________

MC or VISA THREE DIGIT CODE FROM CARD BACK____________________

BILLING ADDRESS – STREET: _______________________________________________

CITY: _________________________________ STATE: ________ ZIP:___________

SHIP TO:_____________________________________________________________

SHIPPING ADDRESS – STREET: ________________________________________

CITY: _________________________________ STATE: ________ ZIP: ___________

AMOUNT TO BE CHARGED TO MY ACCOUNT (USD) $ ___________________________________

    By signing this document below, I authorize Ad Magic to charge my credit card for this order.
The full amount will be charged and estimated shipping will be charged. Additional shipping to be charged
when shipped if amount is more than expected. On orders of 300 decks and up 15 percent overs can be shipped and biilled by factory.
    I accept all responsibility for this transaction and ensure full payment to Ad Magic.

SIGNATURE _______________________________________ DATE ____________

UNSIGNED ORDERS WILL NOT BE PROCESSED !!