Fax Transmission
To:Ainterol HerbsFax Number:18004593067
SubjectCredit card details from for their order from Ainterol Herbs
Please print this form from your browser, complete your credit card details in section 2 and sign and date in section 3 before faxing to us:
 
Section 1 - Your details:
Name:
Address:
,   
Tel:
Email:
 
Section 2 - Credit Card details:
Description:
Currency:
Amount:
Cardholders name (as it appears on card): 
Credit card number: 
Start date - if available: (mm/yy) / Expiry date: (mm/yy) / 
Security code: (3 digits) Issue number - Switch only: 
If you have any questions regarding the processing or storage of your credit card details please read our privacy policy or feel free to contact us.
 
Section 3 - Signature:
Cardholders signature: 
 
Date: 
PLEASE NOTE: Your order will not be processed or shipped until we have received your credit card details.
 
Thank you for making your purchase from Ainterol Herbs.
AinterolHerbs.com
49 Burton Avenue
Plainview, NY 11803
USA
516-216-4832