Authorization Form for a payment by credit card.

I, _____________________________
(Please print your name in capital letters), by the intervention of the undersigned authorizes Contemporary Designs Ltd, Inc. to charge my credit card for the purchase of furniture.

The payment is made by ( )Master Card ( ) Visa ( ) Discover ( ) American Express, numbered _______________________ and expiring on _______ with security code__________(look for 3 digit code on back of most cards/4 digit on front of Amx), in the amount of $ ____________.

I have read the terms and conditions posted online under the Shipping and Return policy and I hereby agree to it. I understand that payments for custom made furniture are non-refundable. Orders for custom made furniture can not be cancelled due to delays in shipping. A 20% restocking fee will be charged on cancelled orders..

Signed at: __________________________________ This _____ day of ________ 200__

__________________________________________
(Signature)

__________________________________________
(Print name in capital letters)
Duly authorized as so he (she) declares

Contact Us:

1 Contemporary Furniture
www.1contemporary.com

27 Dr. Mellichamp Drive, Ste 100
Bluffton, SC 29910 (USA)
Tel: Office (843) 706-9903 | Fax: (843) 706-9913 | Showroom (843) 706-9960
info@1contemporary.com