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Credit Card Authorization

592 Apollo Street, Brea, CA 92821 Sales: (714) 990-2300 Fax: (714) 990-3303






Your completion of this authorization form will help us to protect you, our valued customer, from credit card fraud. All information entered on this form will be kept strictly confidential.


Please fill out the form completely and accurately. We reserve the right to verify the provided information with your Credit Card issuing bank. We are not responsible for delays due to missing or improper information.


I, the undersigned, understand the credit card authorization policy and hereby authorize to charge my credit card for product(s) purchased. For customers with terms, such as Net 30, the payment with a credit card after product is shipped with incur a 3.5% service fee. I represent that the information provided in this authorization is accurate, that the credit card is valid, and it will not be declined. I agree to be bound by applicable policies, terms and conditions, and instructions for this transaction.

(Version 12/2/15)