Customer Name/Authorized User
City State
Zip Code  
Credit Card Type Visa
Name On Card Bank Name On Card
Credit Card Number Expiration Date:
Total Authorized Charge Amount  
 
By signing document below I authorize DigiCombos to ship the goods associated with my charge to:
Name  
Address
City  
State  
Zip  
 
The goods are being shipped to which destination?
 
  As A Gift To:   
  Other:
  Notes/Comments
 Signature:      ______________________________________________________________________________________________________


To Complete Your Order:
Please double check to see that you filled out every field. We cannot process your order if you left anything blank. This form must be faxed to the above referenced number along with a copy of the front and back of your credit card. Your next credit card statement will reflect a charge from DigiCombos.

WARNING: Credit card fraud is a felony. The provision of false credit card information is also fraud. Digicombos will aggressively prosecute anyone attempting to misuse credit card information that they do not own. You must print your card number. 
DigiCombos, Brooklyn, NY. Thank you.

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