Credit Card Authorization Form

Credit Card Authorization Form
Cardholder Name*

First NameLast Name
Business Name*
Credit Card Type*

VisaMaster CardAmexDiscover
Credit Card *
Billing Adress*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I, the cardholder, hereby authorize GLOBAL WHOLESALE VAPOR INC. to charge my credit card & store my information in their system so they charge my credit card for current & future orders on and on-going basis. I confirm that the information for the credit card and billing address is complete and accurate. I understand if I have any issue's or disputes that I will reach out to them directly, and not do any charge backs.

I have been informed that I can cancel my account and have them remove my information from their database by phone or signing a consent form provided by GLOBAL WHOLESALE VAPOR INC.

I, also understand that any invoices unpaid, past due, or charged back will be my responsibility even if the company fails to make payment even if they become insolvent. I agree to being a personal gaurentor for any invoices with a balance to GLOBAL WHOLESALE VAPOR INC.
Date

MonthDayYear
Date
Cardholder Signature

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