Credit Card Authorization and Verification Form

Rings & Things
Credit Card Authorization and Verification Form
Fax (509) 838 2602 * Telephone (509) 252 2900 * Order Toll Free 1 (800) 366-2156
304 E. 2nd Ave., Spokane, WA 99202, USA (shipping)
P.O. Box 450, Spokane, WA 99210-0450, USA (mailing)

– Please print clearly. –


I authorize ____________________________ to use my credit card for purchases from Rings & Things.
                    (name of person)

Card holder signature: __________________________________       Date: ______________

This order’s number: _____________________________

Please accept this letter as authorization to bill my credit card for the following length of time:
   This order only (We will request this information with all orders even if using this card again.)
   Until further notice.

Name of card holder (exactly as it appears on card): ___________________________

Billing address (Complete address, exactly as it appears on credit card billing statement):

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Last 4 digits of card: ________      Expiration date: __________      CVV code: __________
                                                                                                          (On the back of card, in signature field)

Telephone number:______________________   Fax number: __________________________

A copy of the credit card (front and back) must be attached to this authorization.
Please make sure the copy is legible. Thank you for helping control credit card fraud.