RC-SpareParts.com Credit Card Authorization Form

1. Complete the form and fill out all billing and shipping information in the blanks below 2. Print the entire form and sign with the credit card holder's signature on the line indicated. 3. The following supporting documents are required: A photocopy of the front and back of the signed credit card. A photocopy of the card owner's PHOTO ID or PASSPORT A photocopy of the CREDIT CARD BILLING STATEMENT, which can show clear the BILLING ADDRESS 4. Fax or email this form with the supporting documentation in order to complete your order.: Fax: (852) 2745-1771 or Email: sales@RC-SpareParts.com Shipping Address: Name: __________________________ Address 1: _____________________________________ Address 2: _____________________________________ City: __________________ Prov/State: _______ Postal Code: ________ Phone Number: ______________________ Billing Address (if different that above): Name: __________________________ Address 1: _____________________________________ Address 2: _____________________________________ City: __________________ Prov/State: _______ Postal Code: ________ Phone Number: ______________________ Credit Card Information: Credit Card Type (please circle one): Visa / Mastercard / JCB Credit card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date: __ __ / __ __ (MM/YY) CVV Number: __ __ __ __ (This is the 3 to 4 digit number on the back of the card, it is the last numbers in the signature area after the credit card number.) I authorize RC-SpareParts.com (iLinkNow Network Solutions Co.) to charge my credit card in the amount of USD_____________________ For Item(s): ____________________________________________________________________ Order Number: ____________________________ By signing this authorization form, I understand that the charge DO NOT include any duty and tax. I will be responsible for my local country duty and tax (if any). Card Holder Signature ____________________________ Date __ __ / __ __ / __ __ __ __ (DD--MM-YYYY)