CCORDERFORM

CCORDERFORM
Please fill out form below, your credit/debit card will be processed once received & you will receive a confirmation email from Ultimate Toyz, LLC

This type of payment is for ULTIMATE TOYZ, LLC customers who have a CREDIT/DEBIT CARD, but do not have a PayPal Account or do not wish to be charged for PayPal fees, (eg; making layaway payments) You can pay fast & conveniently using this form.

Once this FORM is submitted to us, your credit/debit card order will be processed & your card charged for the amount that you specify. Once your order is processed your information is electronically destroyed. Ultimate Toyz, LLC does not keep credit/debit card information on file, for your protection. If you are making multiple payments you must re-submit credit/debit card information with each payment. To make your transactions easy & more convenient, create an account with ID, for future shopping & payment convenience, to accompany this form. If you do not have a credit/debit card & wish to place an order with a personal check or US Postal Money Order, CLICK HERE.

* Required fields
Name *
E-mail Address *
ITEM # *
DESCRIPTION: *
QUANTITY *
COLOR *
UNIT PRICE *
NAME AS IT APPEARS ON CREDIT/DEBIT CARD: *
ADDRESS OF CARD HOLDER *
CREDIT/DEBIT CARD # *
EXPIRATION DATE: *
3 DIGIT CODE on back of card *
CHOOSE ONE: *	Down Payment on Lay-A-Way Today Making a Lay-A-Way Payment Today Ordering Item/s Today Paying for Shipping charge Paying for Home Delivery charge
Amount Paying Today *
CUSTOMER NAME: *
STREET ADDRESS: *
CITY, STATE, ZIP CODE: *
SHIPPING ADDRESS: (if different from Billing Address)
	By submitting this form I am authorizing Ultimate Toyz, LLC to charge my Credit/Debit card for the amount provided. *
	I have read & agree to the terms detailed in Policy & Warranty Information. *

I have read and agree to the Privacy Policy *

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