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Please
choose the print function on your computer now and
then mail or fax (preferred) below.
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Cardholder
Alternate Shipping Address Authorization
Please
complete the requested information below regarding
a recent credit card charge and request for an alternate
shipping address for a purchase from 123 Online Products
(Corazon,LLC):
I,__________________________________(Card
Holder's Name as it appears on card) authorize
OnlineSCUBA
to charge my credit card __________________(card type,
Visa,MC, Discover...ect.)
Number
________- x x x x - x x x x - __________, Exp Date
Month ___Year____ in the amount of
$________________
, on ___________________(Date) for my ordered product
Inv. # ______. I am also requesting 123Discountsports
to ship my order to the following alternate address
other than my billing address:
(Name)
______________________________________________________
(Company)____________________________________________________
(Address)_____________________________________________________
(City)________________________
(state)_____________ (Zip)__________
(Country)_____________________
(Phone)__________________________
In
an effort to ensure authorized transactions and acknowledgment
of sales, we request that you, as the cardholder,
be aware of recent charges on credit card. By completing
and signing below you agree and authorize Corazon,
LLC to charge your above named credit card for the
agreed amount and to ship the product to an address
other than the billing address.
(Signature)____________________________________(Date)____________________
(Print
Name)__________________________________
Mail
to Corazon, LLC 5230 S.Valley View STE F Las Vegas,
NV 89118 or Fax to 702-897-5644
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