Credit Card Authorization Form

For a printable version of this form click here.  (PDF Format)

To expedite your order, please Sign, date, and fax this form to 937-676-2478.   If you have problems please use the voice
lines at 800-860-2376 or 937-676-2376 or send email to contact@cds.com

I want to order (qty)__________ CD-Recordable discs. The brand name I would like to order is: (circle one) TDK, Sony, Taiyo Yuden, Tuff Coat, Kodak, Mitsui, KAO, Print Write, cheapest, other_______________.

I would like to order (qty)_________ empty Jewel cases.

I want to order the following Hardware for CD-R Duplication:

Item Description                                                             Qty                 Price/item                 Total                        

Grand Total (Ohio residents please add the tax rate for your county)                                                                      

Please ship them to (please print clearly)

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

Phone number in case we have questions or can't read your fax_____________________________

We ship via Federal Express by default. Do you want ______Fed Ex Overnight or _______ Fed Ex Economy? ________Fed Ex 3 day express saver?  We suggest shipping jewel cases UPS but media Federal Express.  Please circle this if you want to split your shipment in this way.  It will save you a considerable amount of money. We will not accept responsibility for shipping media UPS. Do you want split shipment____________? Do you want 100% UPS_______________?

As Cardholder of the following credit card:

Account #________________________________________________Exp. date_________

American Express VISA Mastercard Discover

I do hereby authorize CD Solutions, Inc. to charge my credit card in the amount of $_________ plus shipping fees for the method selected above (no COD orders please).

For product ordered and to be shipped. I understand shipping charges will be added to my purchase amount if I have not included them in the total above.

Signature of cardholder ____________________________________Date:_______________

Cardholder name (print)_____________________________________

Credit card billing address____________________________________

________________________________________________________

Because International Credit cards cannot be verified, this offer is good only for shipments within the United States.

Privacy Statement

Copyright © 2002-03 CD Solutions Inc., All Rights Reserved.

Apollo, Apollo II, Analog to digital, Orbit, Orbit I