Jump For You Credit Card Authorization Form Company Name __________________________________ Contact Person __________________________________ Company Address _______________________________ City ______________________ State ________ Zip _________ Shipping Address ________________________________ City ______________________ State ________ Zip _________ Business Phone _________________________________ Business Fax _________________________________ Email Address _________________________________ Company Website _______________________________ I hereby authorize Jump For You to Charge the credit card listed below On Date ________________ for the amount of $________________ to start production on the unit(s) ordered. For Invoice number _______________ I understand production will not begin until the credit card is charged. I hereby authorize Jump For You to Within 48 hours prior to shipment of the products ordered to charge the Credit Card indicated below for the full remaining balance amount of $_____________ I (Name) ___________________________________________ have read and accept Jump For You terms and conditions. Check One Visa ____ Master Card ____ American Express ____ Discover ____ Credit Card Information Card # _____________________________________ Card holder name _______________________________________ Expiration date Month __________ Year __________ Code on back of Credit card _____________ Credit Card Billing Address __________________________________________ City ___________________________ State _________________ Zip Code __________________ Country ________________________ Drivers License # _______________________ Authorization Signature ______________________ Print your First ___________________________ Last Name ______________________________ Date ______________ If Shipping address and Billing address are not the same, please provide a copy of the credit card (front and back) and your driver license. Please Fax this document to (626) 969-6751
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Authorization Form Copyright 2006 © Jump For You. All rights reserved. Jump For You is a licensed company by the state of California. All images and text are property of Jump for You and can not been used on other web sites, newspapers, or publications. Any business using our name, images, or text will be prosecuted to the full extend of the law. Web site updated on 05/20/2013
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