INTERNET CREDIT CARD AUTHORIZATION FORM

You can also scan in the fom with you signature and email it to us.
Dear Customers : Please print out and fax this form back to us @ 403-217-8432 This form is a necessary security measure for yourself as well as ourselves.
We need to have your signature on file for the credit card company just as if you were in a store and signing for it in person for your purchase.
If you have already given us your full credit card number either by phone or on our shopping cart only include the last 4 (four) numbers on this form.
We thank you for your cooperating and are here to help you
Print this form, using right click mouse button , then print command from the menu, then fill it out.
Fax the form to Fax: 403-217-8432
I hereby Authorize Toneatronic to charge my credit card for a online purchase.

Date__________________________________________

First Name:__________________________ Last Name:__________________________

Method of Payment

(Cheque , Money Order , Credit Card):_________________________

Name on Credit Card:___________________________________________

Mailing Address
Street # & Name of credit card:_______________________________________________________

City:___________________ State/Province: ________________

ZIP/Postal Code: _____________ Country:___________________

Credit Card Type (Visa, Master Card, American Express, credit card/ debit card):

_______________________________

Name of Bank the card is issued

from:_________________________________________________________________

Their Phone#. Usually a 800 number.

___________________________________________________________________________________

Credit Card No:__________________________ Expiry Date:_________________

Pin # __________________________

Signature:_____________________________________________

Customer service phone # on back of credit card:__________________________

FILL OUT THE FORM BELOW FOR YOUR ORDER

ORDERING INFORMATION ITEM # PRODUCT # PRODUCT DESCRIPTION QUANTITY UNIT COST EXTENDED COST