Worldwide Supplier of Commercial Grade Inflatables
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Credit Card Authorization Form

  Jungle Jumps Credit Card Authorization & Term's and Conditions Agreement  
  Date Quote #  
  First Name Last Name  
  Company Name  
  Shipping Address  
  City State Zip  
  Is the Shipping address a Residential location Yes   No  
  If the Shipping address is a Commercial location do you have a loading dock  
  Business Phone Fax Number  
  Web Site Email address  
  Credit Card Information  
  Check One Visa Master Card American Express Discover  
  Name on the Credit Card  
  Card #  
  Expiration Date Month Year Code on back of Credit card  
  Please provide us the address where your credit card statement is mailed to  
  Billing Address  
  City State Zip  
  Drivers License #  
  If Shipping to location of the Inflatables , and the billing address of the credit card is not the same, please fax us a legible copy of your credit card ( front and back side ) and the copy of card holders driver license.  
   
  I have read and accept the terms and conditions of the sale. I hereby authorize Jungle Jumps to charge the credit card for the deposit amount indicated above . I understand that production will not begin until my credit card is charged for the deposit amount indicated. I hereby authorize Jungle Jumps to charge the final payment amount, 3 days prior to the shipment date. Purchase Detail  
  Total Invoice Amount  
  Deposit Amount  
  Final Payment Amount  
     
  Authorization Signature:  
  Print your First & Last Name