Credit Card Authorization Form

Credit Card / Bank Card Authorization Form

Credit Holder Information

Credit Card Information

(Last 3 or 4 digits number on the back of the credit card)
I hereby affirm that I am the owner of the referenced credit card and that my name is listed on the front of the credit card.
I hereby authorize Agency Garment Packing to charge my credit card (listed above)
Keep Card on file for future payments

To process your order, please provide a copy of your identification and a copy of your credit card (both front and back sides).

Copy of Identification *

Copy of Card *