PSS CC Auth - Purple Sticky Salvia™

PSS CHARGE CARD AUTHORIZATION FORM

Store Name *

Corporate name on card *

Name on Card *

Charge Card Information

American Express
Visa
Mastercard

Credit Card # *

Expiration *

CVC# *

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Charge Card Holders Phone # *

Charge Card Holders Email *

Store Main Phone # *

State Resale/Tax ID# *

I HEREBY AUTHORIZE TOE / PSNV LLC / PURPLE STICKY TO CHARGE MY CARD IN FULL FOR THIS & ALL FUTURE ORDERS IF PAYMENT IS NOT RECEIVED BY SPECIFIED TIME ON SAID INVOICE

Authorized Signature

Date

PLEASE INCLUDE PHOTOCOPY OF CHARGE CARD AUTHORIZED AND DRIVERS LICENSE OF AUTHORIZED SIGNER

GoldBuyer program includes free USPS standard shipping with in-house charge card payments where the $500 minimum is met. Shipping fees for UPS, FEDEX, and COD not included in the free shipping program.

Please Note: unless the return or exchange is due to an error on our part, we cannot refund shipping and handling or gift wrap charges. We will issue a credit for future orders. We do NOT refund charge cards or send cash/check refunds.

You are providing your consent to TOE / PSNV LLC / Purple Sticky, doing business as PurpleStickySalvia.com, so that we may send you texts and emails. You may withdraw your consent or view our privacy policy at any time. To contact TOE / PSNV LLC / Purple Sticky, you may write to 2657 Windmill Parkway Suite 137 Henderson NV 89074 or call 1-(866) 463-0083.

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PSS COMPANY CHECK GUARANTEE OF PAYMENT FORM

Whereas, Purple Sticky, hereinafter “Creditor” and “Payer” are about to
execute a document entitled “PSS Company Check Guarantee of Payment” concerning all
products shipped & sold by PSNV.

Store Name / Corp Name *

State Resale # / Tax ID

Payer Authorized Signature

Date

Now therefore, In consideration of the execution of accepting a Company Check, by Creditor and as a material Inducement to Credit to execute said Credit, Guarantors hereby jointly, severally, unconditionally and irrevocably guarantee the prompt payment by Payer of all costs and all other sums payable by Payer under said Credit and the faithful and prompt performance by Payee of each of the terms, conditions and covenants of the said Credit to be kept and performed by Payer. A $50.00 bounced check fee applies to all funds that cannot be collected at the time of payment. In addition to all costs that may be associated with collecting debt if said account is turned over to collections. After 30 days all delinquent accounts will be turned over for Collections. Collections reports to Telecheck, Experian, Equifax and Trans Union as well as assessing an additional 40% of principal amount owed which will be the responsibility of the Payee, if such services are required to collect a debt.

Authorized By:

Signature:

Date:

Social Security #

Drivers License #

Authorized Buyer Name:

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You can send your order via email or text:

chris@purplestickysalvia.com
text: 702.886.2291

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PSS CHARGE CARD AUTHORIZATION FORM

PSS COMPANY CHECK GUARANTEE OF PAYMENT FORM

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