ccform – Collector's Paradise

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Letter of Authorization to Charge Credit Card

I authorize Collector's Paradise, Inc. to perpetually charge to the following described credit card the amount equal to the value of product I have agreed to purchase, until I notify them to stop. The amount I shall be charged, whenever appropriate, as agreed, shall be equal to the total retail value of the product I agreed to purchase, minus any discounts given to me at the time, plus any applicable sales taxes and/or shipping amounts.

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Name on the credit card

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Credit Card Number

Credit Card Type:

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Expiration (YEAR)

Security Code:

Billing Address

Address Line 1

Address Line 2

City

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Zip Code

By typing my name below, I agree that I have digitally signed this form and agree to all the terms above.

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Letter of Authorization to Charge Credit Card

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WEST VALLEY

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NORTH HOLLYWOOD