Credit Card Authorization Form
(Please print this page , complete the information and fax it to the
number listed to the right. Your order will not be processed until we
receive this information.)

JuniorTrends.com

1071 N. Gardner Dr.
Orange, CA 92867
Tel U.S.A.: 1-877.586.4679
International 1-714-633-8044
Fax: 1-714-633-8423

Billing Address:

______________________

Tel:

_________________________________

______________________

Fax:

_________________________________

______________________

Credit Card Type: Master Card | VISA

Expiration Date: _______________
(i.e. 01/2004)

Credit Card #: ____________________________

CIN #: __________
(The last 3 digits on the back of your card)

I hereby authorize Scott International dba juniorTrends to process my order for ORDER# __________________ with the above credit card for the amount of no more than ___________________ (please write original order amount) plus Shipping & Handling fees.*

I agree that I will not initiate any dispute on this charge in the future, for the reason of "No Cardholder Authorization".

I will provide with copy of proof of identity and ownership of credit card upon request.

______________________________
Cardholder signature

______________________________
Date