**Please Print out this form.  Fill it out, and fax to us at 847-891-1286

Credit Card Authorization Form


Invoice/Order #________________  

Name order is placed under (if different than below) __________________________


I _____________________ Authorize Unique Impressions / Par Golf Supply, Inc. to charge my credit card



For services rendered. Not to exceed the amount shown.                   

AMOUNT                    $____________________________USD.                                          

CREDIT CARD TYPE    _________________________________

CREDIT CARD #          _________________________________

CARD CV2 #                _________________________________

EXPIRATION DATE     _________________________________

BILLING ADDRESS      _________________________________


BILLING ZIP/POSTAL  CODE     __________________________

 NAME ON CARD      __________________________________

                                     (As it appears on card)



____________________________________                              __________________

SIGNATURE                                                                                         DATE


FAX OR MAIL TO:                               E-MAIL: [email protected]

Par Golf Supply, Inc.
c/o Unique Impressions

550 Pratt Ave N

Schaumburg IL 60193

Fax: 847-891-1286






INTERNATIONAL ORDERS Please Note: This cost does not include any duties or taxes that may be applied when the order is delivered to you.  We do not have the ability to calculate that fee.