PLEASE READ THIS BEFORE YOU CONTINUE: FORM MUST BE COMPLETED IN FULL, SIGNED BY AN AUTHORIZED USER OF THE CREDIT CARD, AND EMAILED TO OUR ACCOUNTING DEPARTMENT. IF YOU FAIL TO COMPLY WITH THESE REQUIREMENTS WE WILL BE UNABLE TO PROCESS YOUR ORDER. ALL INFORMATION ENTERED ON THIS FORM WILL BE KEPT STRICTLY CONFIDENTIAL BY PRISM BRANDS, LLC.

Authorization to purchase products, goods, and services from Prism Packaging and Design Company on a continuing basis using the credit card described herein and the terms described below, unless otherwise instructed in writing by the credit card holder.

Type of credit card:

Name on credit card:

Credit Card Number

Expiration date:

CVC Code:

CREDIT CARD BILLING ADDRESS

Street:

City

State

Zip Code

REQUESTED SHIPPING ADDRESS

Street:

City

State

Zip Code

As the credit card holder, I hereby authorize the receipt of merchandise at the shipping address above.

Cardholder's Name:

Date:

Checking this box will service as cardholders signature.

I, the undersigned hereby states that the above described credit card is in my name and that I authorize its use to purchase products and services from Prism Packaging and Design Co. and that the total purchases cost will be priced by United States Currency. ADDITIONALLY, I'M FULLY AWARE THERE WILL BE A 3.5% CONVENIENCE FEE WILL BE ADDED TO THE FINAL INVOICE. AS WELL AS ANY STATE SALES TAXES IF APPLICABLE. Orders for sold goods are to be placed by representatives and employers of the above described company via telephone, fax, email, in writing or verbally filed to the account rep. In case of any issues or disputes concerning credit card transactions I will notify Prism Packaging and Design Co. promptly to rectify the situation prior to notifying my credit card company.

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