B-J Marketers & Associates
This form is added protection for both you our valued customers and BJ's.
Thank you for your order.
VOICE (386) 734-0060
C r e d i t C a r d A u t h o r i z a t i o n F o r m
Please print form, fill in and
**FAX (206) 666-CATS (2287) **
If Busy - Alternate Fax with answering machine,
Fax will start after recording plays
**(386)734-0060**
or Mail
as shown below
If you have placed an order through our shopping cart please
write the order number we furnished
you on the line below (Purpose of payment) then print and sign your name exactly
the way it appears
on the credit card you are using in the area provided below, then fax, email
or mail this form to us.
Purpose of payment:_______________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
(Please list the name of product purchased above)
I authorize B-J Marketers & Assoc. (bjmarketers.com) to debit my Credit Card for the sum of USD: $_______.___
Circle appropriate: Amex, Visa, Master or Discover Card, Number:_______________________________________
Exp. Date:_____/_____
Print Name exactly as it appears on the Credit Card you are using:_______________________________________________
Phone # (____)______-_________
e-mail address __________________________________________________________
Signature:_____________________________________________________(Signature is required)
Billing address of Card you are using:
Street:____________________________________City:____________________
State:__________Zip or Postal:________________
Shipping address if different than billing address:
Street:____________________________________City:____________________
State:__________Zip or Postal:________________
Please Fax to: (206) 666-CATS (2287) or (386)734-0060
Mail to: B-J Marketers & Assoc., 2607 S. Woodland Blvd. Unit 307, Deland, Fl. 32720
Shipment of your order will be delayed until
signature form is received.
Please be sure to keep a copy of this order form for your records.
Thank you again for your order!
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