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Letter of Authorization I would like to proceed with my order of clothes from Tailor Fashion

FULL NAME :
PASSPORT NO :
STREET :
CITY :
COUNTRY :
PROVINCE/STATE :
POSTAL CODE :
TEL :
FAX :
E-MAIL :

I authorize Peter Ranee's to


Deduct the sum of:	(Verify Total Amount from E-Mail)
From my Credit Card :
Card Number :
4 Digit Code(AMEX) :		3 Digit Code(VISA)
Expiry Date :	(MM/YYYY)

.......................................................................................(Orders once placed cannot be cancelled)
Signature as on credit card Date

Please deliver my clothes to ( Leave blank if address same above )

FULL NAME :
STREET :
CITY :
COUNTRY :
PROVINCE/STATE :
POSTAL CODE :
TEL :

After Printing, Sign & Fax this form to us. Next, please proceed to MEASUREMENTS.

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