Online Purchase Authorization Form

DMarie's x Dee Purchase Authorization Form

Please fill out this form to authorize an online purchase.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Address MUST match purchase adress*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Please provide the billing zip code: blanks*
Please provide the last four of the card number that is used :blank*
Please upload a GOVERNMENT issued ID

Cancelof
I First Name* Last Name* , the buyer authorize a payment to be made to DMarie's x Dee. I ACKNOWLEDGE AND AGREE TO THE PURCHASE TERMS AND CONDITIONS: By checking this box and proceeding with my order I am verifying that I am the authorized card user and I am fully aware of this purchase. I am are aware of the (Shipping Policy) and (Return Policy) and that there are absolutely no refunds returns or exchanges. I also also agree to not file a chargeback or dispute on my purchase/s. I understand the product I purchase is my own doing.
Authorization Signature

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DMarie's x Dee Purchase Authorization Form