Please Note: 3rd Party Credit Cards are Not Accepted

In lieu of my credit card imprint, I,

Name of Cardholder exactly as Shown on Credit Card

Hereby authorize Data ID Systems to charge my order to the following credit card.
Credit card	VISA MasterCard American Express Discover
Cardholder name
Card number
Expiration date	01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2002 2003 2004 2005 2006 2007 2008 2009 2010
CVV2 Security code	last 3 digits on the back of your card in the signature field
THE BILLING ADDRESS AS IT APPEARS ON MY CREDIT CARD STATEMENT
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Email Address
Phone number
Ship my order to the following ADDRESS (you may experience a delay if different from billing address)
Company Name
Attention to
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Delivery Address	Business Residential
CARD HOLDER AUTHORIZED BILLING SUB-TOTAL AMOUNT:
Sub-total $
Freight $	Freight calculated at time of shipment & added to invoice
Taxable Y N	Tax calculated at time of shipment & added to invoice
Total Billed to Card $	Amount including freight and tax billed to card Amount including freight billed to card

Order#

P.O. #

Invoice #

By signing below and submitting for payment, I acknowledge acceptance of the Terms and Conditions, accept and agree to all cancellation and/or re-stock penalties and agree to all charges. I also agree to waive any charge-back rights and in the event of a dispute, requests for a refund must be submitted in writing along with all order documentation in accordance with standard policy of company issuing credit card. We will gladly exchange or accept for return items which are defective and subject to the manufacturer's warranty terms. All other items MAY, at our option, be accepted for return with a restocking fee or credit to account only as outlined in our terms of sale.

This form must be completed in full and all information must be true and correct in order for your order to be processed. Print out the form, sign it and send it along with copies of your license and credit card both front and back. These documents must be received via secure fax or mail prior to shipment.

FAX to (408)354-9533 U.S.A.