Credit Card Authorization Form

(Please print this page, complete the information and fax it to the number listed to the right. Your order will not be processed until we receive this information.)

Minsung Ko CPA IRS EA


6131 Orangethorpe Ave. Suite 350, Buena Park, CA 90620
Tel: 562-552-1991 Fax: 877-775-3297
Company Name  
Cardholder Information
Name (as stated on card)
Billing Address  
 
Tel
Fax
Credit Card Type American Express
Visa
MasterCard
Credit Card #
Expiration Date
(i.e. 01/2011)
CVV #
(The CVV is the 3 digit number located on the back of your card)
Note: In the case of AMEX the CVV is the 4 digit number on the front of the card.
Please check all boxes
I hereby authorize Minsung Ko CPA IRS EA to process my order PO# _______________ and/or INV# __________________ with the above credit card for the amount of no more than ___________________ (please write original order amount) plus Shipping & Handling fees.*
I agree that I will not initiate any dispute on this charge in the future, for the reason of "No Cardholder Authorization".
I will provide with copy of proof of identity and ownership of credit card uponrequest.
* Rates may vary depending on the carrier of choice.
Cardholder Signature
Date