CREDIT CARD AUTHORIZATION FORM

CREDIT CARD AUTHORIZATION FORM

Please complete and submit this form in order to provide authorization for Paradise Fence Supply to process your credit card payment. (NOTE: This form is for authorization purposes only. Submitting this form will NOT automatically charge your credit card.)
Cardholder Name*

First NameLast Name
Business Name
Business name if company card
Email Address
example@example.com
Phone Number*

Area CodePhone Number
Credit Card Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Dollar amount to be authorized*
Please enter the dollar amount authorized for this charge. (NOTE: This will NOT charge your credit card)
Credit Card Authorization Provided To:
Company you are authorizing to charge your credit card
Type of Authorizaation*

Blanket Approval (This and future orders)Single Authorization (This order only)
Date*

MonthDayYear
Date
Cardholder Signature*

Clear
Once you have completed the form simply click the "Submit Form" button below to send this form securely to us.

- THIS WILL NOT AUTOMATICALLY CHARGE YOUR CARD -

Optionally, if you prefer to print a copy of this form, click the Print Form button. The completed form along with photo ID can then be sent to us at

Fax: (888) 858-1705 or Email: orders@ParadiseFenceSupply.com

NOTE: If printing the form for fax or email
please provide only the last 5 digits of the credit card number
If you need assistance completing this form please contact one of our customer service associates by calling (347) 331-0000
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