Credit Card Authorization Form
  • To prevent the unauthorized use of your credit card, EUROCOM requires this authorization form to be completed.
  • Place credit card on box below and photocopy form.
  • Authorize the charges to your credit card by signing below.
  • Fax signed form to 1-613-224-2511 or email to sales@eurocom.com
    		•
    Place credit card here
    Copy of ID showing your signature
    or
    Copy of back of credit card
    Order Confirmation #:
    Total Amount:$
    Credit Card #:
    Expiry Date (mm/yy):
    Card Verification Value (CVV): [3 or 4 digits]
    I agree to pay the total amount as entered above according to the card issuer agreement. I hereby authorize EUROCOM or its subsidiaries to charge the above credit card for this amount. I agree to be bound by EUROCOM's terms of use and to follow the instructions for the return of any merchandise.
    Signed:________________________________________________
    Date:________________________________________________
    Cardholder:________________________________________________
    Address:________________________________________________
    City, State/Province:________________________________________________
    ZIP/Postal Code:________________________________________________
    Phone:________________________________________________
    Email:________________________________________________