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CREDIT  CARD  ORDER  APPROVAL  FORM

To prevent credit card fraud and increase security,
we request your signature approval to use your credit card.

INSTRUCTIONS:
1)  Print this Page
2)  Fill Out Credit Card Information Below
3)  Sign and FAX this Page and approved quote form to 1-914-244-1995 (USA)
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The card holder listed below gives LOGO premiums .com, a division of 
MesMerized Graphics, approval to use this credit card for placing orders.

CREDIT CARD TYPE ___________________________________________________
                                                         (visa or mastercard accepted)

CREDIT CARD NUMBER ________________________________________________

EXPIRATION DATE  ____________________________________________________

3-DIGIT SECURITY NUMBER (if available)  _________________________________

CARD HOLDER NAME  _________________________________________________

CARD HOLDER PHONE NUMBER  _______________________________________

CARD HOLDER ADDRESS ______________________________________________

SIGNATURE  __________________________________________________________

PRINT NAME  ________________________________     DATE _________________

PURCHASE ORDER # or REFERENCE # (if available)  _______________________

Thank your for your order
Email your questions to our LOGOpremiums.com Credit Manager  
manager@logopremiums.com