ONE TIME USE
YS GARMENTS, INC. dba
3128 E. Harcourt Street, E. Rancho Dominguez, CA 90221-5511
Tel: 310-631-4955 Fax: 310-631-6097
CREDIT CARD AUTHORIZATION FORM:
FAX THIS FORM TO: 310-631-6097
COMPANY NAME
CREDIT CARD #
ISSUING BANK
SECURITY CODE
TYPE
MARK "X"
AMEX
MASTER
VISA
EXPIRATION DATE
MONTH-YEAR
FULL NAME (AS APPEARS ON THE CREDIT CARD)
CREDIT BILLING ADDRESS:
PLEASE INCLUDE A PHOTOCOPY OF THE FRONT AND BACK OF THE ABOVE
(PHOTO COPY ON LIGHT SETTING FOR LEGIBLE FAX.)
THE FOLLOWING PERSON, IF ANY, ARE AUTHORIZED TO USE THIS CREDIT CARD ON MY BEHALF:
I understand that I am obligated to notify Next Level Apparel / YS GARMENTS INC. if there is any change
in authorized users. I further understand and agree that my credit card account will be charged in the event
the card is used by former authorized users, unless I notify Next Level Apparel / YS GARMENTS INC., in
writing, of changes in authorized users.
This application will be valid only during the valid date of the credit card and must be renewed at the
expiration date.
A SIGNED PURCHASED ORDER IS REQUIRED.
CARDHOLDER SIGNATURE
TEL#
FAX #
DATE
RETURN FORM TO THE CREDIT DEPARTMENT