CREDIT CARD HOLDER’S AUTHORIZATION TO CHARGE CREDIT CARD
Team Name: Credit Card Billing Address:
Street Address: Street Address:
State: Zip: State: Zip:
Please initial and date next to all charges that you authorize: Initial Date
❏ Deposit (approximately 50%) of custom order
in the amount of: $ __________ ______ ___/___/___
❏ Balance of custom order in the amount of: $ __________ + freight ______ ___/___/___
❏ Squadra gear inline order in the amount of: $ __________+ freight ______ ___/___/___
❏ Squadra fit sample order in the amount of: $ __________ + freight ______ ___/___/___
By signing below , I acknowledge the charges described hereon. Payment is to be made in full
when billed in extended payments in accordance with the standard policy of the company
issuing the card.
In lieu of my credit card imprint, I______________________ hereby authorize Squadra Inc. to
charge my credit card. Please choose card and fill out the information below.
Expiration Credit Card Verification Number:
(CCV Last 3 digits found in your signature box)
Name on Card
Please complete this form and fax it to Squadra Inc. at 760-431-4767. This form must be
completed in full including signature, date, and CCV. All information must be true and correct in
order for the order to be processed. Please print clearly as illegible forms can not be processed.
5900 Sea Lion Place #140 • Carlsbad, CA 92010
phone: 760•431-0870 • fax: 760-431-4767
email@example.com • www.squadra.us