Authorization Form

Authorization Form
This authorization form is to protect you (customer) and us(Cartterbait llc) from any fraudulent purchases.

This form must be filled out in its entirety for your order to be processed and shipped.
I, {cardholderName}, as a cardholder, hereby authorize Cartterbait LLC to charge my credit/debit/shop pay card for {exact item amount} and confirm that the information for the credit card and billing address is complete and accurate.
Cardholder Name*

First NameLast Name
Exact Item Amount *
Order Number(s): (ex. 00098)*
Email*
Ex: info@info.com
Phone number*
Please enter a valid phone number
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you purchase item(s) in-store or online?*

In-storeOnline
I am aware that my order will not be shipped until I complete this form in it’s entirety.*

I understand and agreeI disagree
I have completely read the description of the item I have purchased.*

Yes
All sales are final. There are no returns or exchanges. If there is an issue with your order, please contact info@cartterbait.com*

I understand and agreeI disagree
What are the last four digits of the card used to purchase item(s).*
Are you authorized to use of the card that you purchased your item(s) with and provided the last four digits for?*
Please upload Photo ID (Name and Address on ID must match the name and address on order.)*

Cancelof
Date*

MonthDayYear
Date
Cardholder Signature*

Clear
Should be Empty: