Credit Card Authorization form – High Quality Distribution

Credit Card Authorization

For High Quality Distribution to accept and bill your Credit/Debit card, please complete all fields below, sign, date, and upload a copy of your ID and a picture of your Credit/Debit Card, front and back, (cell phone pictures are acceptable).

All information sent is strictly confidential and High Quality Distribution adheres to the highest standards for account data protection.

I HEREBY AUTHORIZE THE TRUSTEES OF THE ABOVE COMPANY TO BILL MY CREDIT CARD ACCOUNT

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Company Name

Date / Time

Cardholder's information (must appear exactly as on the Credit/Debit card statement)

Multiple Choice

Visa
Mastercard
AMEX
Discover

Name on The Card

Credit Card Number

Expiration Date

CVV/CVV2

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Estimate/Invoice Number

Please note all credit card payments will have an additional 4.6% fee added for each invoice.

Authorization:

I hereby authorize High Quality Distribution to charge the Credit/Debit Card indicated above. I agree that I will be responsible for all payments via such Credit/Debit Card. I agree that I will not dispute High Quality Distribution billing with my Credit Card issuer. I guarantee and warrant that I am the legal cardholder for this Credit/Debit Card and I am legally authorized to enter into this one-time or recurring billing agreement with High Quality Distribution.

I am aware and understand the High Quality Distribution Policy that all orders have no return or exchange policy.

(Please note that your Credit/Debit card billing statement will show it as "High Quality Distribution".)

Confirmation

By checking this box, I also confirm that I’m authorized to use this card for future orders and agree that I will be responsible for all payments via this Credit/Debit card.

ID Upload

Click or drag a file to this area to upload.

Please upload a copy of your ID

on Email Billing

Card (front)

Click or drag a file to this area to upload.

Please upload a picture of the front of your Credit/Debit card

Card (back)

Click or drag a file to this area to upload.

Please upload a picture of the back of your Credit/Debit card

Credit Card Authorization

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