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Serenity Designs
AmysLingerie.com
PO Box 692
Jupiter FL 33468

Fax # 270.209.1714

AmysLingerie.com Shipping Authorization

This document is for your protection and ours. If you do not wish to complete this from, you have the option of simply contacting your bank and having them list a secondary address on your account. We can then verify the information over the phone with your bank. We appreciate your cooperation in preventing online credit card fraud and for helping to make the web a safer place to shop. Failure to adhere to our policy will result in the delay of your order and automatic shipment to the billing address.


Date:__________________________________________________

Order #:_______________________________________________

Cardholder Name:________________________________________

Billing Address:__________________________________________
(address on file with credit card company)   

City/State/Zip:___________________________________________    

Phone Number:__________________________________________

E-mail Address:__________________________________________

If Shipping to Alternate Address:

Shipping Address:__________________________________________    

City/State/Zip:___________________________________________    

By signing this form, I certify that I am the true cardholder and hereby authorize AmysLingerie.com c/o Serenity Designs to bill the following credit card for merchandise cost and applicable shipping charges in the amount of $____________. I further authorize shipment to be made to an address other than my billing address (if applicable). Signing this form also indicates that I have read and understand the terms of sale, including shipping, delivery and return policies as outlined on the web site.

Visa______ MasterCard______ American Express______ Discover Card______
(please check one)

*Card Issuing Bank's phone number:____________________________
(for verification purposes - printed on back of card or credit card statement)

Card Number
______________________________Expiration _____/_____
Cardholder Signature: x___________________________________  Date: __________

 

 

 

 

PLACE FRONT OF                                         PLACE BACK OF
CREDIT CARD HERE                                CREDIT CARD HERE 
    Must be light and legible                                Must be light and legible    

 

 

 

COPY OF DRIVERS LICENSE
OR PHOTO I.D. HERE
 Must be light and legible

 

 

 

 


 

 

FAX TO 270.209.1714
International Customers: +001.270.209.1714
E-mail:
Sales@AmysLingerie.com
Web site: http://www.amyslingerie.com/