CREDIT CARD AUTHORIZATION FORM-PRINT AND FAX TO US

YOU MUST PRINT, FILL OUT AND FAX THIS FORM BACK TO US AT THE NUMBER BELOW IN ORDER TO PROCESS YOUR ORDER

208 Swope St.

Hilger Montana 59451

　

CREDIT CARD AUTHORIZATION FORM

WE ACCEPT THE FOLLOWING CREDIT/DEBIT CARDS: VISA, MASTERCARD, DISCOVER AND AMERICAN EXPRESS

This sale is subject to the published conditions of the Purchase. If the terms of this purchase state "All Sales Final" no returns or adjustments can be considered. If the therms indicate a guarantee the guarantee is specific and limited only to those specific points of coverage. On all other points the sale is final and no refund or adjustment can be considered. Any and all disputes shall be resolved according to the published printed terms of purchase. By signing below you are stating that you have read and accept our return policy. You are also stating that you have downloaded this form from our return policy page located at www.montanacustomhay.com and clicking on link Return Policy.

In order to authorize us to charge your credit card this form must be completely filled out and faxed back to us.

PLEASE PRINT CLEARLY

CARD TYPE: _____VISA ______MASTERCARD ________DISCOVER _______AMERICAN EXPRESS

CARD NUMBER: ________________________________________

EXPIRATION DATE: _______/__________

VERIFICATION CODE:_____________ 4-DIGIT CODE FOR AMEX; 3-DIGIT CODE ON SIGNATURE STRIP ON BACK OF CARD FOR ALL OTHERS

BILLING INFORMATION

CARD HOLDER NAME:______________________________________

ADDRESS: ________________________________________

_________________________________________

CITY: _________________________ STATE: ____________ ZIP CODE: _____________________

PHONE: ( ) ___________-_____________

I AUTHORIZE MONTANA CUSTOM HAY TO CHARGE THE ABOVE CREDIT CARD IN THE AMOUNT OF $_________________ .

I UNDERSTAND THAT IF I USE A DEBIT CARD, MY CARD MAY BE CHARGED ½ ON DAY ONE AND ½ ON DAY TWO DUE TO BANK RESTRICTIONS ON THE DAILY LIMITS FOR DEBIT CARDS.

SIGNATURE ___________________________________________________ DATE: __________________________

PRINTED NAME: ________________________________________________

PLEASE FAX BACK TO 406-538-6812 TO COMPLETE YOUR TRANSACTION

WE CANNOT PROCESS YOUR ORDER UNTIL WE HAVE THIS FORM COMPLETED

IF YOU HAVE QUESTIONS REGARDING THIS FORM PLEASE CALL US AT 800-692-0474