Credit Card Customer Authorization/Application:

To be Paid to: Caught-In-The-Act

Box 406, 1741 Rainforest Lane, Ucluelet, British Columbia, V0R3A0

phone or Fax 250-726-7100 (0900-2200 PST)

 

Please process on my: Visa____ or Mastercard ____

Credit Card Number _______________________________________________

Card Expiry Date: month_____ year____ CVV2 - 3 digit number on back of card____

Must have the number on the back of the CC to process order.

Total Amount of Sale____________________________________________

I understand that receipt of goods may take 21 days from date shipped

Product Description line 1: ___________________________________________

Product Description line 2: _____________________________________________

Cardholder's fax number ________________________

Cardholder's Contact phone Number - Daytime___________________

Cardholder's Contact phone Number - Evening ___________________

Cardholder's Name (print) _________________________________________

Cardholders Address as per credit card

Street__________________________________Apt./Unit_________________

City________________________State/Prov_____ Zip/Postal Code_________

Cardholder's Signature ____________________________________________

Date:______________________________