AUTHORIZATION LETTER

AUTHORIZATION LETTER

ALLZONEDVD.COM
Merchant ID : 802389

My Order :

First Name : ..............................................................................

Last Name : ..............................................................................

Mailing Address : ....................................................................

.....................................................................................................

....................................................................................................

Off. Tel : ..................................................................................

Res Tel : ................................................................................

Fax :  ......................................................................................

Email :  .....................................................................................................

I hereby authorize ALLZONEDVD.COM to charge US $ .................to my VISA / MASTERCARD Credit Card for goods purchased by me.

Card Details

Card Holder's Name...........................................................................

O VISA O MASTERCARD

Card Number :.....................................................................................

Expiry Date : ......................................

Three Digit Verification Code

Card Holder's Signature...................................................

FOR STORE OFFICALS ONLY
Package Dispatch Date :................................... Dispatched By :................................................	Authorization Code : ................... Authorization Date : .................... Authorized By :...........................

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