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Credit Card Authorization Signature

To avoid delays in processing your first-time order with credit card payment method under one of the following four situations, please fill out this credit card authorization form, print it, sign it, and then fax it to us.

(1) If your billing address is different from the shipping address.
(2) If you are using a foreign credit card, for which we can't verify the billing address or zip code.
(3) If the billing address you gave on your order form is inconsistent with what's on the credit card record, for which we contacted you via phone or e-mail verification.
(4) If we encounter problems such as disconnected or not-working telephone numbers in our attempt to verify your order.

Rules: (1) Please fill out this form after placing your order. (2) You do not have to fill out this form again if you have done it once before unless the shipping to address is different from your last order. (3) We cannot guarantee that your order will be shipped immediately after receiving this form by fax. Further verification may be necessary under some, but rare situations.


Credit Card Authorization Form

To (Seller): Directron.com, 10402 Harwin Drive, Houston, TX 77036
Fax No. 281-754-4965

Buyer Name:

Order Number: Order Amount: $

Credit Card Number:

Credit Card Type:

Bank that issued the credit card:

Phone number for the credit card:

By signing below I testify that I am the credit card holder for the above referenced credit card. I authorize Directron.com to charge my credit card for the order amount shown above including shipping. I agree to pay Directron.com the above total amount according to card issuer agreement.

Print Your Name:



Credit Card Holder Signature: _____________________________

Date: _______________________

Attachments:

(1) A picture ID showing identical name.

(2) A copy of your credit card, front and back.

Notes: (1) In case a problem with the fax line, use another fax number: 713-773-9393. (2) This page is not captured or sent in any way. Filling out the form electronically would not get your data sent through the Internet or stored anywhere. You'll print this page, sign it and fax it to us. If privacy is still a concern, you can print this out as a blank form and fill the info with a pen.


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