2017 Beauty logica no price main

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TEL 866.518.5272 | FAX 773.267.1346 | info@beautylogica.com | www.beautylogica.com

CREDIT CARD AUTHORIZATION Please PRINT CLEARLY in blue or black ink

Customer Information:

LAST NAME

FIRST NAME

MIDDLE NAME

COMPANY NAME

ACCOUNT NUMBER (YOUR BUSINESS TELEPHONE NUMBER)

Billing Address:

NAME AS IT APPEARS ON CREDIT CARD

STREET ADDRESS

APT/UNIT/PO BOX

CITY

STATE

ZIP

Credit Card Information* Credit Card:

Visa

Mastercard

Expiration Date:

/ MONTH

Credit Card #:

-

-

YEAR

-

Daytime Telephone Number:

CARDHOLDER SIGNATURE

DATE

*ALL CREDIT CARD INFORMATION WILL BE USED FOR BEAUTY LOGICA ORDERING PURPOSES ONLY AND WILL BE KEPT ON FILE FOR THE CUSTOMER’S CONVENIENCE UNLESS THE CUSTOMER STATES OTHERWISE. A BEAUTY LOGICA SALES REPRESENTATIVE WILL CONTACT THE CUSTOMER AFTER EACH ORDER IS RECEIVED TO VERIFY CREDIT CARD PAYMENT INFORMATION. IF THE CUSTOMER WISHES TO USE A DIFFERENT CREDIT CARD, THE CUSTOMER WILL BE PROVIDED WITH NEW AUTHORIZATION FORMS FOR NEW CREDIT CARDS.

INFO@BEAUTYLOGICA.COM

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