CREDIT CARD PAYMENT AUTHORIZATION TO SHIP MERCHANDISE TO AN ALTERNATE ADDRESS

FAX  - Completed form to: (602) 433-7401 -  ATTN: MARITZA
EMAIL  - Completed form to: murena@superiortattoo.com - Must be in .jpg format
CARDHOLDER -
Please complete the following section with attached photo copies of Credit Card/Driver's Licenses and sign/date below:
Credit Card Billing Name:
Credit Card Billing Address:
City: State: Zip Code:
Daytime Telephone: Evening Telephone:
Email Address:
Credit Card Issuing Bank Name: Bank Phone Number
(Back of your Credit Card):
Ship To Name:
Ship To This Address***:
City: State: Zip Code:

***IMPORTANT:If your shipping address is outside of your billing zone... Additional fees may apply.

BY SIGNING BELOW, YOU AUTHORIZE SUPERIOR TATTOO EQUIPMENT TO SHIP YOUR MERCHANDISE PAID BY
CREDIT CARD TO AN ALTERNATE SHIPPING ADDRESS.

Print your name:
Signature: Date:
Please choose the one of the following: (Please Circle)
I want my order sent here one time only I want all my future orders shipped here

PLEASE ATTACH PHOTOCOPY OF CREDIT CARD (FRONT & BACK) & A CLEAR
PHOTOCOPY OF DRIVERS LICENSE ON A SEPARATE PAGE.
INCOMPLETE OR UNREADABLE FAXES OR FORMS WILL NOT BE ACCEPTED.

FRONT OF
CREDIT CARD
Block out all but last 4 digits		 BACK OF
CREDIT CARD		 FRONT OF
DRIVER'S LICENSE		 BACK OF
DRIVER'S LICENSE

If you are photo copying your card PLEASE use the lightest setting as they tend to be too dark to read.
Superior Tattoo is NOT responsible for any loss of the package by sending it to an alternate address.

**This step is to prevent credit card fraud and is for your protection. Once noted on your account, the page with the credit card and driver's licenses photo copies will be shredded or deleted upon approval. For your protection you can block out all but the last 4 digits and the security code on your credit card. Please make sure any photocopies or scans are clear and easy to read.