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 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