Payment by Credit Card Fax
Information Form
Address: Digital Power Pro, Inc,
Fax#: 1-801-593-9706
Please fill out this form to
pay for your item(s) by credit card. We accept Visa, Mastercard,
or Discover. Once you have the form filled out you can fax it to us or mail it
to us at the address above. If you have any questions about filling out the
form or other payment methods please contact us at payments@digitalpowerpro.com The
address must be the address that your credit card statements get mailed to or
it will be declined and delay your products payment and shipment. Also be sure
to include the 3 digit verification code (vcode) on
the back of the card following your account number to help in getting your
credit card approved quickly. For more information on the vcode
please go to http://www.digitalpowerpro.com/vcode.htm
Items must be sent to the billing address of the credit card to prevent fraud.
* = Required Billing/Shipping Address
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* Name: |
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(optional)Company Name: |
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*Address: |
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*State/City/Postal Code: |
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*Country: |
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Card Information
* Check one: Visa MasterCard Discover
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*(16 numbers) Card Number: |
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*Expiration Date(MM/YY): |
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*Name as Appears on Card |
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**Vcode (3 digit #) |
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Item Information
If you have your online
checkout page with item details and shipping totals you can bypass this section
and send it as a separate page.
Check here if sending a separate
page.
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*Item Number |
(optional) Item Description/Title |
(optional) Item Part # |
$ Price in US Dollars |
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1 |
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$ |
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2 |
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$ |
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3 |
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$ |
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4 |
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$ |
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5 |
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$ |
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6 |
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$ |
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7 |
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$ |
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8 |
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$ |
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9 |
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$ |
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10 |
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$ |
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(optional Shipping insurance, add $1.00 per $100.00 of value) |
$ |
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*Shipping and Handling |
$ |
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(Tax will be added for all |
$ |
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If more items are needed to be listed please list on another page.
*Signature______________________________ Date______________(MM/DD/YYYY)