Printable Credit Card Order Form

B-J Marketers & Associates (4walkingsticks.com) - Phone (386) 822-9046

C r e d i t C a r d A u t h o r i z a t i o n F o r m

Please print form, fill in and

**FAX (206) 426-2584**

or Mail as shown below

If you have placed an order through our shopping cart please write the order number we
furnished you on the line below (Purpose of payment) then print and sign your name exactly the way it appears on the credit card you are using in the area provided below, then fax, email
or mail this form to us. This is added protection for both you and BJ's; Thanks for your order.

Purpose of payment:_______________________________________________________________________________________

____________________________________________________________________________________________________

(Please list the name of product purchased above)

I authorize B-J Marketers & Assoc. (4walkingsticks.com) to debit my Credit Card for the sum of USD: $_______.___

Circle appropriate: Amex, Visa, Master or Discover Card, Number:_______________________________________

Exp. Date:_____/_____

Print Name exactly as it appears on the Credit Card you are using:_______________________________________________

Phone # (____)______-_________

e-mail address __________________________________________________________

Signature:_____________________________________________________(Signature is required)

Billing address of Card you are using:

Street:____________________________________City:____________________

State:__________Zip or Postal:________________

Shipping address if different than billing address:

Street:____________________________________City:____________________

State:__________Zip or Postal:________________

Please Fax to: (206) 426-2584

Mail to:B-J Marketers & Assoc., 2607 S. Woodland Blvd. Unit 307, Deland, Fl. 32720

Shipment of your order will be delayed until signature is received.
Please be sure to keep a copy of this order form for your records.
Thank you for your order!

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