Payment Authorization Form
RosseeyyBeauty
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
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
Your E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Order #
*
What did you order?
*
Wig Revamp
Create your Own
Other
Other ..
Do you agree to authorize this wig purchase ?
*
Yes
No
Do you understand that shipping is 14 Business days ?( Business days are Monday-Friday)
*
Yes
No
Please type the last 4 digits of the card used to make your Purchase
*
Please Sign confirming that you are the owner of the card used to make your purchase
*
Please Sign Confirming that you agree to the no returns or exchange policy.
*
Please Load Any Inspiration Pictures ( by signing this document you agree that i can get as close to the picture as i can that it may not be exact . )
*
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Please type the name you signed above .
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