Use this form if one of the following situations applies to your placed order.
Your billing address is different from the shipping address when placing an order.
Also use this form if you are using a non major or foreign credit card, for which we can't verify the billing address or zip code.
If the billing address you gave on your order is inconsistent with whats on our records for verification.
If we encounter problems such as disconnected or not-working telephone numbers in our attempt to verify your order.

INSTRUCTIONS:

Please print the text in the section below the dotted---------line. Then please fill out this form after placing your order.
Fill out this form if the shipping to address is different from your last order.
We cannot guarantee that your order will be shipped immeidately after receiving this form by fax. Further verification may be necessary under some, but rare situations.

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CREDIT CARD AUTHORIZATION FORM

To (Seller): ivitex.com, 18685 Main Street, Suite A. Huntington Beach, California, USA
Fax 714-848-7139

Buyer Name:

Order Number:

Order Amount: $

Credit Card Number:

Credit Card Type:

Bank that issued the credit card:

Phone number for the credit card:

By signing below I testify that I am the credit card holder for the above referenced credit card. I authorize ivitex.com to charge my credit card for the order amount shown above including shipping. I agree to pay ivitex.com the above total amount according to card issuer agreement.

Print Your Name:

Credit Card Holder Signature:

Date:

Attachments:
(1) An official picture ID showing identical name shown on credit card.
(2) A copy of your credit card, both front and back.

NOTES:

The ivitex billing department agrees to maintain high standards while ensuring that all online information is true and accurate for protection to the card holder. Which provides the best in customer service and security, we also ensure you the purchaser, have the credit card in possession and authorize ivitex.com to place charges to your credit card by the requested online order. When ivitex.com submits your card number through its billing system, we may contact the issuing bank of the credit card for notations of any restrictions or address information changes. This applies to all credit card orders that are made via telephone, mail, or Internet. All for the protection against fraudulent activity, ivitex.com verifies credit card billing address and CID numbers with all online orders placed.
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