Application for Credit Card Details

Name (as it appears on the card)

Address: (where credit card statements mailed to)

Is ship to address the same as above?

Yes No

(If credit card billing address is different from the shipping address, customer must call Credit Card Company and advise that he wants to receive shipment at that address.)

Telephone number Ext.

Listed in above name at the above address

Listed Not Listed Listed in above name at different address

Address where listed.

This is to confirm that I, authorize PerfumeBox.com to charge invoices billed to shipped to

This also serves as a release form. Should I have any claims or problems with a shipment or order, I will first attempt to solve it with PerfumeBox.com customer service in good faith.

Signed: Date:

Application for Credit Card Details

Application for Credit Card Details

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