Credit Card Authorization Form

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Credit Card

Cardholders Name

Name of issuing Bank

Credit Card Number

Card Type

AMEX
Visa
MasterCard
Discover

Expiration Date

Security Code

A 3 digit number usually located in the back

Billing Address

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Documents Upload

A Copy of a Government Issued Photo ID

Click or drag files to this area to upload. You can upload up to 2 files.

Front and Back. Accepted files: jpg, jpeg, pdf, png, doc, docx

A Copy of the Credit Card

Click or drag files to this area to upload. You can upload up to 2 files.

Front and Back. Accepted files: jpg, jpeg, pdf, png, doc, docx.

Sign and Submit

Signature

Clear Signature

By Signing above you authorize P.A.C. TRADING GROUP, INC. to charge your credit card above for agreed upon purchases. By signing you also understand that your information will be stored for future transactions on your account. By Signing you assume all responsibility related to these charges and waive any rights to dispute charges upon receipt of goods