Credit Card authorization

							                                                                                                                  Credit Card authorization



order details

purchase order number                                                                     peter pepper work order number



customer name and address                                                                 shipping name and address (if different)




Card details




cardholder’s name and card statement address                                              card number



                                                                                          expiration date                          security code




                                                                                          cardholder’s signature



ContaCt details                                                                           speCial instruCtions
contact name                                                                              please limit card charges to the below amount

                                                                                           $

phone                                   fax                                               please keep my card on file for future orders



email address                                                                             cardholder’s initials




p l ea s e contact cus tom er s erv ic e if you have any questions.
P 800 496 0204 F 310 639 6013 E customerservice@peterpepper.com

privacy policy
Names, addresses, billing details and other information submitted to Peter Pepper Products, Inc. or through our sales reps are not sold or shared with any third parties.