Credit Card Authorization Form – Racebox

Credit Card Authorization Form

Name *

First

Last

Business Name

Email *

Phone *

Billing / Shipping Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Invoice Number *

Invoice Amount *

Name on Card *

Credit Card Number *

Expiration Date (MMYY) *

Security Code / CVV *

Zip Code *

Customer Agreement and Acknowledgements *

I authorize RACEBOX LLC to charge my credit card above for agreed upon purchases.
I would like RACEBOX LLC to store my information for future transactions on my account.
I understand that the sale of any RACEBOX product or service is final at the moment of checkout. RACEBOX will adhere to an “all sales are final” policy unless there are circumstances that, in the sole and absolute discretion of RACEBOX, make a return or refund appropriate.

Signature *

Date *

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