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Credit Card Authorization Form


Authorization Form for Purchase(s) that are on Hold or need added information verifications.

This form is used when your paypal-small-logo.jpg Paypal account has

Unverified Address
or Unverified Names


ivitex Credit Card Authorization Form

To avoid delays in processing your order with credit card payment method under certain situations.
It is madatory that you fill out all fields of this credit card authorization form, simply print THIS PAGE, fill in all areas, sign it, and then fax it to us.
If information area fields are left blank your authorization form will be rejected.
If you need help with this form, call us at 1-888-563-7910 or email:


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.
*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 information on our records for verification.
*If we encounter problems such as disconnected, busy or not-working telephone numbers in our attempt to verify your identity for pending order.


Please print this form. Please fill out this form completely 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.


To (Seller):, 18685 Main Street, Suite A. Huntington Beach, California, USA

Fax to +1-714-766-8496 Attention Billing Department

Buyer(s) First Name, Middle Name, Last Name: _________________ ________________ __________________________

Company Purchaser Full Name and Credentials: ______________________ ______________________________

Order Number: _________________________

Order Amount:
$ € £ _________________

Credit Card Number and CID Number on the back of credit card: ____________________________________ ________

Credit Card Type: VISA - MASTERCARD - AMERICAN EXPRESS - MAESTRO _______________________________

Bank that issued the credit card and Bank Telephone : _______________________ ___________________________

Buyer or Purchaser(s) Phone number(s) associated to the credit card: _______________________________________

By signing below I testify that I am the credit card holder or authorized purchaser for the above referenced credit card. I authorize to charge my credit card for the order amount shown above including any extra shipping, packaging, fees, special handling, export/import tariff, taxes and duties. I agree to pay the total of the order, invoiced sales transaction or any post modified total amounts according to purchase(s).

Print Your Common Full Name: ______________________________________________

Signature of Bank Issued Credit Card Holder: ___________________________________________________________________

Todays Date: _____________________________________

Please scan, fax these Attachments:
(1) A copy of an official picture ID such as drivers license, passport, national ID card, must be showing identical name shown on credit card used.
(2) A copy of the credit card used for this purchase, please show both front and back of credit card.
(3) A copy of your credit card, both front and back.
(4) A copy of utility bill which is current, (within 2 months) such as: Home or Business Phone bill, Electricity bill, Insurance bill, Bank Statement.


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 to place charges to your credit card by the requested online order. When 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, fax, by mail, or Internet. All for the protection against fraudulent activity, verifies credit card billing address and CID numbers with all online orders placed, Thank you for your help.