Purchase Authorization Form

Purchase Authorization Form

If requested, the completed authorization must be received within 2–3 business days after purchase. The actual payer must sign their own authorization. Do not provide a full card number or CVV.
Shopify Order and Customer Details
Shopify Order Number
Buyer Legal Full Name

First NameLast Name
Checkout Email
example@example.com
Order Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Item or Service Ordered
Order Total
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Shipping/Delivery Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Payer Confirmation
Are you the person who paid?
Payment authorization
Payer legal full name

First NameLast Name
Payer email
example@example.com
Payer relationship to shopper
Fulfillment
Method of Fulfillment
Delivery Recipient Name

First NameLast Name
Delivery Recipient Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Delivery Instructions / Notes for Another Shopper
Required Acknowledgments
I confirm the order number, item, and amount are accurate.
I am the payer and authorize fulfillment of the referenced order.
I understand custom-made or preorder processing may take 7–14 business days unless the specific listing or written agreement says otherwise, and shipping time is separate.
I acknowledge the applicable return/refund, processing/shipping, and wig care/service policies at stitchedbytanna.com.
I will promptly report any issues and understand I retain the right to contact my payment provider or dispute under applicable law.
I confirm I am the payer and authorize payment for this order.
Optional Notes and Payer Signature
Optional Notes
Last Four Digits of Payment Card
Payer Signature
Printed Name
Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Purchase Authorization Form

Shopify Order and Customer Details

Payer Confirmation

Fulfillment

Required Acknowledgments

Optional Notes and Payer Signature