Credit CardAuthorization Form Order Number * As indicated on emailed invoice from order@zipphaus.com. Cardholder Name (as shown on card) * Card Type * American Express Visa Discover Mastercard Other (please specify in 'Additional Details' section) Card Number * Card Expiration (MM/YY) * Please provide expiration date as shown on card. Billing ZIP Code * Additional Details Authorization * By marking 'Yes' you are authorizing the charge to the card in the amount indicated on the emailed invoice. You also confirm that you are authorized to use this card on behalf of the person listed in the original order form. Yes Thank you!
