Weston Blinds (c) 2005-2011
A Division of Scippa & Associates Corporation
All Rights Reserved
CREDIT CARD AUTHORIZATION FORM
* Required Field
Date:
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*Card Holder Name:
*Card Type:
*Card Number:
*Expiration date:
MM/YY Format
*CVV2:
Three-digit number on the back of Visa, Mastercard, Discover and Bank cards
Four-digit number on the front of American Express cards.
*Card Holder Street Address:
*Card Holder Zip Code:
*E-mail Address:
E-mail required to send Receipt & Confirmation
*AMOUNT:
For example: 1,500.00
I AUTHORIZE WESTON BLINDS & SHADES TO CHARGE MY ACCOUNT FOR THE ABOVE AMOUNT.    BY SUBMITTING
THIS FORM, I AGREE TO PAY CHARGES ASSOCIATED WITH THE INVOICE FOR THE PURCHASE ACCORDING TO THE
CARD ISSUER AGREEMENT. CREDIT CARD PROCESSING VIA TRANSFIRST.COM SECURE SERVER.  
IMPORTANT NOTICE:  ALL DEPOSITS AND PAYMENTS WHETHER PARTIAL OR FULL, ARE NON REFUNDABLE.  
WESTON BLINDS & SHADES WILL NOT START PRODUCTION UNTIL PAYMENT IS RECEIVED.  WINDOW TREATMENTS
ARE CUSTOM MADE PRODUCTS THEREFORE THEY ARE NOT RETURNABLE FOR ANY REASON EXCEPT WARRANTY
REPAIR.
If you prefer to submit the authorization by other means (fax or
scan by e-mail) please download the PDF version of this form
and fax it back to (954)349-6784 or scan and mail it to
support@westonblinds.com