Please print and fill out this form for International orders placed with a credit card and/or for orders with a different ship to: address than the bill to: address provided with your order. Then Fax it to us or land mail it. This is NOT an interactive form you can fill out online. You MUST print it and then fill it out and send it to us. Once we have your information on file we will not need to request this of you for future orders provided you use the same credit card and address information.

Below you will find a credit card authorization form. We only use this form when we are shipping the order to a name and address other than the billing address or for international credit card orders from banks not in the USA and/or not participating members of our verification service.

Please fill it out, sign it  (the cardholder), and fax it to us. You can fax us at 718-896-1527 in the USA. We are just outside of NYC and our fax is on 24/7. Our land mail address is:

Internetwork Partners
110-64 Queens Blvd.
Suite 478
Forest Hills, NY 11375

We do this to protect you and us both! We need this returned via fax or land mail to us within 72 hours (or 3 business days) to avoid unnecessary delays in processing your order. Thank you for your cooperation in this matter.

Fax/ Voice: 718-896-1527

Email: sales@elegantharlot.com  

Our verification service is CardService International. You may contact them to verify we are required to ask this information of you. The CardService web site is www.cardservice.com

CREDIT CARD AUTHORIZATION 

I hereby authorize and acknowledge that I am the cardholder making this purchase from Internetwork Partners, dba Elegant Harlot, Elegant Harlot Creations, Lavendar's Latex Lair and/or Lavendar's Sexy Love Toys, who will charge the referenced credit card for my purchase and shipping charges.  I further authorize shipment to be made to an address other than my billing address (if applicable).

Refer to Invoice# _____________

Amount________________ 

DATE ____/____/____

_________________________________    
(PRINT) Cardholder Name

________________________ 
Card Account Number (include last 3 digits found by signature section on back of card (Except American Express Cards)) 

Expiration Date   ___/___/___  (day/month/year)

This is a :
MasterCard___
Visa___
American Express___
Discover___ 

_______________________________  
Print Name (as it appears on card) 

Print Billling address below AS IT APPEARS ON YOUR BILLING STATEMENT! 

_____________________________________                  

_____________________________________

_____________________________________

_____________________________________

_____________________________________
Phone number of credit card issuing bank (on the back of your credit card)

Place CLEAR copy of credit card here with front and back image.

I swear under penalty of prosecution that the information submitted with  this form is true, accurate and that  am the cardholder authorized to make this transaction.

_______________________________ DATE        /      /     
Signature