Order Verification Form

Order Verification Form

Thank you for your order! Please complete the Gluluxe order verification form within 24 hours of placing your order. Your order will not be shipped until this form is complete. Failure to fill out this form within 24 hours will result in processing, pick up/shipping delays or order cancellation.
Gluluxe 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 Gluluxe 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*

Powered by Jotform SignClear
I agree that this purchase is legit and I am the owner of the card being used to make this purchase*

Powered by Jotform SignClear
Please upload your photo ID (Name on card and ID must match)*

Cancelof
Should be Empty: