Credit Card Authorization Form

Please print this form and fax the completed copy to 1-503-296-5304 (USA). Payments will be processed within  two (2) business days.

           I, hereby, authorize J & P International LLC to process a charge on my Credit Card, for the amount I’ve been credited as per their invoice for my order. I certify that I will use a genuine Credit Card, which I am authorized to charge. I enclose with this letter a Credit Card and Photo ID that I hold as a measure to certify my authenticity.

Card Details

Type: VISA [  ]/ Master Card [  ]/ AMEX [  ]
Name on Card: ________________________________________________
Card Number:  __________________________ Expiry: _____ / _________
                                                                         (MM / YY)
Signature on Card: ___________________________

Other Details

Street:________________________________

City:__________________________ State/Province:________________

Country:_________________________ Zip/Postal Code:___________

Telephone:_________________       Email:_________________________
 

Place a photocopy (back and front) of your credit card and Photo ID here: