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www.uigolf.com

**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

                (NAME)                                                                                

 

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: jen@pargolf.com

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.