Billing Address

Store dba Name * Your Name * Email * Address City

State

Zip *

Telephone *

Payment Method

I authorize Freestyle Brands, LLC to charge transactions to the following credit card

Accepted Cards *

Name on Card * Credit card number *

Exp Month *

Exp Year *

CVV *

Please check the applicable box I approve charges for this transaction and any subsequent transaction approved by card holder to billed to this card number. I approve Charges For This Transaction Only. If you select this option, you will be required to sign this form for each subsequent transaction.

Any credit card payments made after the ship date will be assessed a 3% fee.

Credit Card Authorization Form

Billing Address

Payment Method