J & D
Productions, LLC.
1637 Revell Downs Drive
Annapolis, Maryland 21401
Phone: (410) 626-8850 Fax: (410) 757-6945
Email: jdproduct@comcast.net Website:
www.jdproduct.com
CREDIT CARD AUTHORIZATION FORM
Credit Card
Type: Visa or MasterCard PO or Reference Number:_______________
(PLEASE ADD 3% TO ORIGINAL TOTAL)
Credit Card Billing Address: (Must match address EXACTLY as listed on billing statement) PLEASE PRINT
| Card Holder Name: | __________________________________________________ |
| Credit Card Number: | __________________________________________________ |
| Expiration Date: | __________________________________________________ |
| Address: | __________________________________________________ |
| City/State/Zip: | __________________________________________________ |
| Telephone Number: | __________________________________________________ |
| Fax Number: | __________________________________________________ |
I, ______________________________, hereby authorize J & D Productions, LLC to charge my credit card the amount of $_____________________.
Signature of Card Holder: _______________________________________
Merchandise Shipping Address: (Must use street address in case we do not use the US Mail) PLEASE PRINT
| Name: | __________________________________________________ |
| Address: | __________________________________________________ |
| City/State/Zip: | __________________________________________________ |
| Telephone Number: | __________________________________________________ |
| Fax Number: | __________________________________________________ |
Please fax or mail the completed form to J & D Productions, LLC