Credit Card Authorization Form
Credit Card Authorization form: Download PDF File and email to sales@hdhinc.com
SHIPPING INFORMATION:(all fields are required)
Company/Name: |
Contact: |
||
Phone: |
Email: |
||
Shipping Addr: |
|||
City: |
State: |
Zip: Country: |
ORDER INFORMATION: (attach 'Online Shopping Cart' or 'Estimate' if available)
Prices are subject to verification
# | Item ID | Description | Finish/Style | Qty | Unit Price | Total Price |
1 | ||||||
2 | ||||||
3 | ||||||
4 | ||||||
5 | ||||||
6 | ||||||
7 | ||||||
8 | ||||||
9 | ||||||
10 | ||||||
Sub-Total |
||||||
PA Residents Add 6% Sales Tax |
||||||
Shipping & Handling |
||||||
GRAND TOTAL |
BILLING INFORMATION:(all fields are required)
Credit Card Type: |
Visa | MasterCard | Amex | Discover |
CC Number: |
Exp Date (mm/yy): | |||
Owner's Name: |
||||
Billing Address: |
||||
City: |
State: | Zip: | ||
Signature: |
Date: |
If you are paying by "CHECK", please mail your check to:
Home Decor Hardware, Inc., 200 S. Franklin St # 8D, West Chester, PA 19382
COMMENTS: (please provide additional information if
necessary)