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Serenity Designs
PO Box 692
Jupiter FL 33468

 Fax # 270.209.1714 Shipping Authorization


This document is for your protection and ours. If you do not wish to complete this form, the following options are available:

1)  Send money order or cashiers check
2)  Receive package at your billing address
3)  Contact your bank and have them list a secondary address on your account.

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)

Phone Number:__________________________________________

E-mail Address:__________________________________________

Alternate Shipping Address:

Shipping Address:_____________________________________________________________________    


By signing this form, I certify that I am the true cardholder and hereby authorize 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    




 Must be light and legible






FAX TO: 270.209.1714    /  International Customers: +  
Web site: