Purchase Authorization Form

Purchase Authorization Form

Thank you for your purchase! Please complete this form at your earliest convenience, failure to complete this form within 48 hours will result in processing, pick up/shipping delays or order cancellation.
Imperial Virgin Hair is subject to verify all orders by requesting proof of payment and identification. All information MUST match your order. None of your information will be shared under any circumstances, this information is obtained to protect our business from fraudulent disputes/chargebacks. In the event of a fraudulent dispute, please note that this contract will be used against you as a form of evidence for this purchase.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Order Number & Order Date*
I have authorized a purchase from Imperial Virgin Hair LLC on the date and for the order listed above.*
Do you agree to our Terms of Service and Store Policies/Conditions?*
By signing this I agree to forfeit all rights of filing a dispute/chargeback for this purchase.*

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I agree that this purchase is legit and I am the owner of the card being used to make this purchase.*

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Photo ID ( Card Holder )*

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