BASICTEMPLATES.COM: Third-Party Credit Card Charge Authorization Form
PO Box 342, Belle Valley, OH 43717 USA
Fax: (877) 704-0548 [Extension 1, Option 2]

Print, complete and sign the form below. Mail it or fax it with these other required documents. All requested information and documentation is required or we cannot process the order. If not received within 7 working days, this order will be canceled.

  1. a copy of the cardholder's credit card (front only)
  2. a copy of the cardholder's drivers license or other type of photo ID


Cardholder's Name ______________________________________________________ (please print)

Cardholder's Billing Address

__________________________________________________________________________________

City ______________________________________ State/Prov. ________________ Zip ___________

Country ______________________________________

Telephone: _________________________________ (landline only - no cellular)

Email: __________________________________ (Must be your real ISP email or paid website email.)

Order No. _____________________________ Date of Order: ________________________

Total Amount of Purchase to be charged to my credit card: $________________

Type of card: ____________________ (Visa-Mastercard-Discover-American Express)

Card number used to place this order: ____________________________________________

Bank Phone Number on the back of the card: ____________________________________________

I, the undersigned agree, understand and authorize the amount shown above to be charged to my
credit card for the items shown on the referenced order.

These items are being purchased by me for:

_______________________________________________________ (print full name of "Third Party").

I understand these charges will appear on my credit card statement under the name of FinalAffect.Com and I accept full financial responsibility for payment of this order per the Terms of Use located at www.basictemplates.com/terms.shtml. I agree payments are non-refundable and that the copyrighted designs/membership I am paying for will be solely licensed and accessible to the individual person listed as the "Third Party" above.

Further I am also enclosing a copy of the front of my credit card as well as a copy of my legal driver's license or other photo ID for identity verification purposes.

Signature of Cardholder: _____________________________________________________________

Date Signed: ______________________________________


Mail *ALL* required documents to: BasicTemplates.com, PO Box 342, Belle Valley, OH 43717 USA -or- Fax *ALL* required documents to: (877) 704-0548 [Extension 1, Option 2]