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China florist shop Authorization & Guarantee Form

Tel: 0086-13621338500 Fax: 0086-10-69181904
Email: [email protected]

Please print out this form, fill out the blanks, EMAIL or fax it back to us. 

Your name:_______________Your Country/Region:_______

Your Email Address: ____________________________

Your Telephone Number: ______________________

Credit Card Type : ________   (Master Card, AE,  VISA , JCB Card ONLY,)

Credit Card No : __________________

CVV2 No.: ________ ( it is the last 3 (for visa, master card) or (4 for American express card) -digit number printed on the back of your card. It appears after and to the right of your card number.)

Expiry Date : ____________________________

Cardholder's Name (same with your card’s) : __________________

Your billing address:  ______________________________

Your billing city:  ______________________________

Zip Code:  _____________________


1. Gift ID:                        UNIT PRICE:

2. Gift ID:                        UNIT PRICE:

Delivery Date: (MM/DD/YY)  __________________

1.  Recipient Name: _______________________

2. Recipient Tel.:_____________Mobile Phone: __________

3.. Recipient  Address:____________________________

4. Card Messages or what else do you need:


If you have printer and fax machine, you can fax the above credit card details to our office 008610-69181904 (Beijing, China),  If you haven't , you can copy the info, fill in and email to us [email protected] . If the recipient is in the countryside, more USD10 will be more added.  

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DOC. file for Authorization & Guarantee Form 

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