Immediate Apparel
1220 S Maple Ave. (Suite 1207)
Los Angeles, CA 90015
Tel: (213) 742-6800
CREDIT CARD AUTHORIZATION FORM
I, ______________________________, hereby authorize Immediate Apparel to charge my credit card
account in the amount not to exceed: $________________________.
Credit Card:
American Express Master Card Visa Other ___________________
Credit Card #: __________________________________________________________
Expiration Date: ______________ VID Code: _________
Cardholder Name: ____________________________________
Billing Address: _________________________________________________________
________________________________________________________________________
Ship to Address: _________________________________________________________
______________________________________________________________________________
* If shipping address is different from billing address, please call your bank and request to add the
shipping address as a secondary address to your credit card account.
CUSTOMERS OUTSIDE THE U.S
For faster verification, please provide your bank’s information below:
Bank Name:_________________________
Contact Person (if available): _______________________________
Telephone No.________________________
Email address: ________________________
This authorization will be used for any charges now and any future use unless you notify us in
writing that you no longer want us to use this credit card.
I am the authorized signee for the above credit card account.
_______________________________ _________________________
Cardholder’s Signature Date
ATTN: _______________________