SHELL HORIZONS 14191 63rd Way  Clearwater, FL 33760 | Fax: 727-536-8888

CREDIT CARD PAYMENT AUTHORIZATION & ORDERING FORM All first time customers must fax in their order

NOTE: I AGREE THAT I HAVE PURCHASED FROM SHELL HORIZONS USING MY CREDIT CARD AND MY CREDIT CARD WILL BE CHARGED ONE TIME FOR GOODS AND FREIGHT. THERE WILL BE NO TAX, NO HANDLING FEE’S. SHELL HORIZONS CANNOT TELL YOU HOW MUCH YOUR SHIPPING CHARGES ARE PRIOR TO SHIPPING YOUR ORDER. WE WILL SHIP THE FASTEST AND MOST EFFICIENT WAY GROUND.

Full Name:
Address:
City State Zip:
Telephone:
(For Tracking Packages) Email:

Quantity	Item Number		Quantity	Item Number

I AUTHORIZE SHELL HORIZONS, INC. TO PROCESS FULL PAYMENT OF MY ORDER USING MY CREDIT CARD.

Credit Card Number:		Expiration Date:
Printed Name:		Security Code:
Signature of Cardholder:		Today's Date:

Your signature must match name on credit card and name on order.

FAX This Form To: (727) 536-8888
Freight will be added to order after order is packed