Credit Card Authorization Form

Credit Card Authorization Form

Due to strict credit card processing rules, Obscurities Tattoo/Piercing Studio requires an authorization form for all transactions when the card is not present. We apologize for this inconvenience.

This form will NOT send your credit card information over the Internet. It simply allows you to print a filled in authorization form.

Step 1 - Fill in all text boxes.
Step 2 - Print this page.

Step 3 - Initial and Sign form at bottom
Step 4 - Fax to (214) 528-3297

Name
(as appears on card) Visa Master Amex

Credit Card # Exp. Date

Daytime Phone # Fax #

E-mail address Security Code

Billing address for credit card.

Street City State Zip

_____
initial

I authorize a charge of $ to the above credit card as a deposit for a tattoo appointment. (Please call for exact amount)

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initial I understand that the charge will be processed immediately and is non refundable unless the appointment is canceled at least 7 days prior.

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initial
If I am more than 15 minutes late, I agree to forfeit my scheduled appointment and a percentage of my deposit, the amount of which to be determined by the artist.

Credit Card Holder's Signature:_____________________________ Date:___________

Once payment is processed you will receive a phone call to confirm appointment.
Obscurities INC - 4000-B Cedar Springs Dallas, TX 75219 - Voice: (214) 559 3706 - Fax: (214) 528 3297

Billing address for credit card.
Street		City		State		Zip

DO NOT FILL OUT ITEMS BELOW - FOR INTERNAL USE ONLY
Tattoo Artist	______________________	Tattoo Design	______________________
Date	______________________	Time	______________________
Artwork	______________________	Client Called	______________________
Artist Notified	______________________	Client	New Return

Name (as appears on card)		Visa Master Amex
Credit Card #		Exp. Date
Daytime Phone #		Fax #
E-mail address		Security Code