Please print, complete, and FAX or mail back the Credit Card Authorization form with your AUTHORIZED SIGNATURE, so that we may process your order. Please note, you may also fill out the form, scan it, and send it back by e-mail as a *.pdf or*.jpg attachment.

UNIVERSITY APPAREL
320 Beverly-Rancocas Rd, Suite 1-G
Willingboro, NJ 08046
phone: 609-871-3601 ~ fax: 609-871-3602
http://www.fraternalregalia.com

Credit Card Authorization Form

Customer Name:_________________________ 

Billing Address:_______________________

City/State/Zip:__________________________

Home Phone: ______________________ Work/School Phone: ___________________

E-Mail address: _________________________@______________


SHIP TO Name (If different from above):_________________________ 

SHIP TO Address (If different from above):_______________________

SHIP TO City/State/Zip:__________________________

Note: Shipping addresses must be COMPLETE. There will be a minimum fee of $5.00 to CHANGE  invalid shipping addresses, either prior to shipping or in-transit.

INVOICE #_________________ (if applicable)

Credit Card (circle one):     MC     VISA     DISCOVER

Please impress card in the space below:








Place card under form, numbers facing up. Hold card in place and rub pencil point across the block, using moderate pressure. Please ensure that all information, including cardholder name is completely traced above.

Card #: ___________________________________ expiration date: _______

Cardholder Name: ___________________________  3 Verification Number*: ______

Cardholder Signature: ___________________________ Date: _____________

*For your safety and security, we now require that you enter your credit card's verification number. For MasterCard, Visa or Novus (Discover) cards, the verification number is a 3-digit number printed on the back of your card. It appears after and to the right of your card number. (see sample below)

 

This is to advise that University Apparel is authorized to accept orders from me by e-mail, telephone, or fax, charge the cost of such orders to my credit card account, and to ship the merchandise to the address that I provide. By signing this document, I accept all responsibility for these transactions and ensure full payment to the merchant. I will inform you immediately if use of this card is no longer valid. 

Please print, complete, and FAX or mail back the Credit Card Authorization form with your AUTHORIZED SIGNATURE, so that we may process your order. Please note, you may also fill out the form, scan it, and send it back by e-mail as a *.jpeg attachment.