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 :
_____________________________________________
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.
Terms: 50% DEPOSIT charged now and balance will be charged upon shipment.
I accept all responsibility for this transaction and ensure full payment to Ad Magic.
SIGNATURE _______________________________________ DATE ____________