Credit Card Authorization Form – Promogo Gifts LLC

Credit Authorization Form

First Name

Last Name

Company

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Credit Card Number

Expiration Date

CVV

Total Amount (3.00% handling charge included)

I certify that all information is complete and accurate. l hereby authorize PROMOGO GIFTS LLC to collect payment byprocessing a charge to the credit card listed above. l certify that l am the authorized signer of the credit card listed above