Customer Agreement and Authorization Form
Customer Details:
Full Name
*
First Name
Last Name
Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Order #
*
Agreement to authorize this purchase
*
Please Select
Yes
Confirm the last 4 digits of the card used to make your purchase
*
I agree that this purchase is 100% legit and I am the owner of the card being used to make this purchase
*
I agree that Her Units by Eastlyn is not responsible for any lost, damaged, or stolen goods during mail transit
*
I agree to the no refunds or exchanges policy
*
Upload your ID
*
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