Customer Authorization Form
Full Name
*
First Name
Last Name
Order #
*
E-mail
*
example@example.com
Phone Number
Please enter a valid phone number.
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
Payment Method Used:
*
Please Select
Credit/Debit Card
Klarna
Afterpay
Shop Pay
Affirm
Last 4 Digits of Card Used:
*
I authorize Her Vault to charge my payment method for the order listed above.
*
Please Select
Yes, I agree
I confirm that I am the authorized cardholder and that all information provided is accurate.
*
Please Select
Yes, I do
I understand that all sales are final and I agree to the returns/refunds policy.
*
Please Select
Yes, I understand
I agree that Her Vault is not responsible any lost, damaged, or stolen packages.
*
Please Select
Yes, I agree
Please upload your ID:
*
Browse Files
Drag and drop files here
Choose a file
Please note that this is for security precautions. Your ID will not be stored in our database.
Cancel
of
Signature
*
Submit
Should be Empty: