Credit Card Authorization – Wholesaler Website

WE DO NOT SELL TO PRIVATE INDIVIDUALS – ONLY LICENSED WHOLESALERS, RETAILERS, AND DISTRIBUTORS

Credit Card Application

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Thank you for your response. ✨

Type of Card

Name as it Appears on Card

Credit Card Number

Expiration Date

YYYY-MM-DD

CVV Number

Billing Information

Address

City

State

Postal Code

Recurring Payments

Permission(required)

YES

1. You are giving Drunk Chicken Cigars permission to retain your credit card information and to charge the credit card on file for all future purchases with no prior notification.

2. This authorization will remain in effect until terminated, either by Drunk Chicken Cigars or by the Cardholder. Drunk Chicken Cigars reserves the right to cancel recurring payments in the event of a declined charge, chargeback, or if instructed by the card issuer. The Cardholder may cancel this authorization or change the account information for recurring payments by notifying Drunk Chicken Cigars in writing prior to the next charge.

Credit Card Authorization Agreement

1. By signing below, you are authorizing Drunk Chicken Cigars to charge your credit card accordingly (if recurring payments is checked “yes” then you agree to the terms for recurring payments above).

2. Your credit card will be charged once your order has shipped.

3. The charge will appear on your credit card statement, and on your request, a receipt can be emailed to you.

4. A decline charge may result in termination of this authorization. If there is a decline, you will be notified, and no shipment will be made until new payment is received either via the same credit card or a new card. A new card will require a new credit card authorization be signed.

Credit Card Authorization Signature – Completed By:

COMPANY Name

First Name

Last Name

Job Title

Phone

Signature

Today’s Date

YYYY-MM-DD