Credit Card Charge & Policies Agreement Receipt/Form


Billing Information

(R) First Name: (R) Last Name:
(R) Address 1: Address 2:
(R) City: State/Province:
(R) Zip / Postal Code: (R) Country:
(R) Phone: Fax:
(R) Email: Company:

(Select Card Type) Visa MasterCard Discover American Express
(R) Card Number:      (R) Expiration Date: (xx/yyyy)


This is a legal agreement between the card owner and DoroPaintball.inc
I the card owner hereby authorize DoroPaintball.inc to collect payment via the credit card listed above for orders placed either verbally or online. I hereby authorize DoroPaintball.inc to collect payment via the credit card listed above for extra shipping costs and products added to an order after the final sale. I have read the policies of DoroPaintball.Inc and agree with and understand those policies. I have verified that the billing information above is correct. I understand that comments written in the comments box below will not be part of this agreement unless specified by a representative of DoroPaintball.Inc. I certify that the statements herein are true, complete and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information is punishable by law.

Comments:

Card Owners Signature: ___________________________________________ (Signature must be hand written)

FAX COMPLETED FORMS TO 706-549-4900 (United States)