PLEASE
PRINT THIS FORM OUT THEN FAX OR MAIL IT TO ADDRESS BELOW. This enables you to
place orders without having to phone. We can hold your card on file and you can
then just email us the go ahead to charge your card or have it automatically
charged.
PLEASE FAX to 61 (07 )
41518743
Or EMAIL sales@beadinspired.com
Consent to beadinspired.com – Storage and Use of
Credit Card Details..
ABN
58546819977
Name on Credit Card : ______________________________________
Credit Card Number : ______________________________________
Expirey Date : ________________________________________
Type
of Card (eg Visa) : _______________________________________
Do
you require an email before processing : Please
Circle....
NO
YES Please email only for transactions
above AU$_______
(indicate $0 if email if required every time)
I acknowledge that beadinspired.com requires my/our credit card details in order to
pay for goods/services in relation to order/s placed.
I /we therefore consent to beadinspired.com
1. Storing my/our personnel information.
2. Storing my/our personnal information But NOT including on computer.
3. Using and disclosing my/our personnal information.
For the purposes of providing the goods/services my/our organsiation has requested.
AUTHORISED SIGNATORY : ________________________________________
( must be cardholder)
Full Name of Signatory ___________________________________________
Address: ________________________________________________________
Date : ____________________________________________________________