Personalized by Design Credit Card Authorization Form
(800) 945-5522
Please fax to: (973)
728-7043
Order Number (if known):________________________
Credit
Card Number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp.____________
Name
as it appears on card: ______________________________________ Phone
number: (_____)_______-__________ Address
Card bill is sent to: Address____________________________Apt.
#________ City_____________________State__________Zip_________ Phone
number: (_____)_______-__________ (Very
Important!!) Chocolate
bars and/or personalized wrappers Quantity:
________ Occasion:
_______________ X____________________________________ Authorized Signature For office use only:
Card Verification Number: __ __ __ __
(With MasterCard or Visa there is a number printed on the signature strip on the back of the credit card.
The card verification number follows the credit card number. It is the last three digits of it.
On Amex cards, the number is a 4-digit number on the front of the card.)
