Shipping Authorization Form

Serenity Designs
AbsoluteCorsets.com
PO Box 87031
Vancouver, WA
98687

Fax # 928.585.2136

This document is for your protection and ours. If you do not wish to complete this form, you have the option of sending a money order or cashiers check instead, receiving your package at your billing address, or contacting your bank and having them list a secondary address on your account. We can then verify the information over the phone with your bank. We appreciate your cooperation in preventing online credit card fraud and for helping to make the web a safer place to shop. Failure to adhere to this policy will result in the delay and/or cancellation of order. (EXCEPTION: options above are not applicable for international addresses, Authorization form must be received as address verification is not verifiable through international banks via phone).

Order #:_______________________________________________

Cardholder Name:________________________________________

Billing Address:___________________________________________________________________
(address on file with credit card company)

City/State/Zip/Country:______________________________________________________________

Phone Number:__________________________________________

E-mail Address:__________________________________________

If Shipping to Alternate Address:

Shipping Address:_____________________________________________________________________

City/State/Zip/Country:__________________________________________________________________

By signing this form, I certify that I am the true cardholder and hereby authorize AbsoluteCorsets.com c/o Serenity Designs to bill the following credit card for merchandise cost and applicable shipping charges in the amount of $____________. I further authorize shipment to be made to an address other than my billing address (if applicable). Signing this form also indicates that I have read and understand the terms of sale, including shipping, delivery and return policies as outlined on the web site.

Visa______ MasterCard______ American Express______ Discover Card______
(please check one)

*Card Issuing Bank's phone number:____________________________
(for verification purposes - printed on back of card or credit card statement)

Card Number ______________________________Expiration _____/_____
Cardholder Signature: x___________________________________ Date: __________

PLACE FRONT OF                                         PLACE BACK OF
CREDIT CARD HERE                                CREDIT CARD HERE
    Must be light and legible                                Must be light and legible