Name on Card:_________________________________________
Address:______________________________________________
Address:______________________________________________
City/Town:_____________________________________________
State/Province:________________________________
Zip/Postcode:_________________________
Country:______________________
Telephone: __________________________________________
"X" Type of Card: Visa ____ MasterCard ____ AMEX____
Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Expiration Date: ____/____ CVV2 Code: __ __ __ __ (Last 3 or 4 digits on back of the credit card)
I agree to pay the total amount as entered above according to the card issuer agreement. I also understand that I am responsible for all shipping costs to return any merchandise for refunds or exchanges. I am also responsible for the shipping costs to return exchanged merchandise back to me.
Cardholder signature:_____________________________________
Date:____________________
NOTE:
- Charges appear as Sly Fox MX Closeouts on your credit card statement.
- All credit card information is kept strictly confidential and will not be given or sold by Sly Fox MX Closeouts.
- Contact us with any questions: 317-861-8478 or email: Support@SlyFoxMX.com
Fax this completed form and the above credit card page to:
011-317-890-0447 or 1-317-890-0447
Thank You!