Please allow us to charge you for the amount below so that we may process the order we have for you! If you have any questions or concerns, please call! Pat (912) 596-1755

CREDIT CARD AUTHORIZATION FORM
I hereby authorize Patrick's Uniforms to charge my credit card:

Card Number:

3 Digit Code:
Expiration:

Billing Zip Code:
Todays Date:

Name on Card:

Billing Address:




Typed Authorized Cardholder Signature*

There is no need to print out, sign, and fax/mail back this form. Your TYPED signature is all we need!*
*The UCC defines the term signature as any name, Trade Name, assumed name, word, or other identifying mark used in lieu of a signature (§ 3-401(2)).
The term signed is defined by the UCC as any symbol executed or adopted by a party with the "present intention of authenticating a writing" (§ 1-201(39)).


ALL FIELDS ON THIS FORM MUST BE FILLED IN COMPLETELY, AND THE FORM MUST BE SIGNED (TYPED) BY THE CARD HOLDER IN ORDER TO PROCESS THIS CREDIT CARD TRANSACTION. THANK YOU.

Thank you for submitting this Design Form to Patrick’s! We will have someone from our Art Team get back with you as soon as possible! Many thanks!