FOREIGN USED AUTO PARTS, LLC.
Credit Card Authorization Form
BILLING ADDRESS
Cardholder
Name
Company
Address
Address
City/State/Zip
Telephone
SHIPPING ADDRESS
Name
Company
Address
Address
City/State/Zip
Telephone
Card Type
Visa
MasterCard
Discover
Credit Card
Number
Expiration:
AUTHORIZATION CODE:
AUTHORIZATION TO CHARGE CREDIT CARD
I, ________________________________, hereby authorize Foreign Used Auto
Parts to charge my credit card account in the amount of $________
Shipping/Core Charge: $_________
Total: $_________
For
________________________________________________________
I hereby authorize Foreign Used Auto Parts, LLC. To charge the amount shown above to the card specified
above. I agree to pay the above credit card charges in accordance with my Card Issuer Agreement. I
understand that Foreign Used Auto Parts, LLC. Will apply a charge back fee to my account ($50.00US) if I
initialize a “charge back” with my credit card issuer, to reverse payment without Foreign Used Auto Parts
LLC’s permission of any of the charges authorized on this form, and I agree to pay this fee if this occurs.I
also understand that if for any reason I refuse this shipment,the freight charge will be charged to my credit
card. All parts returned must be returned completely as shipped and are subject to a minimum of 30%
restocking fee.
Signature _____________________________________ Date: _____________________
Please fax back to (303) 296-7480