Letter of Authorization

Today's Date:

  • Please print and complete this form, and fax it to us. Do not send by email for security sake.
  • Please have your credit card ready to fill out the form.
  • Name and address must be the same as given to the credit card company
  • Click here to print this form.
Name on Card:
Email Address:
(please provide your email address)
Address Line 1:
Address Line 2:
Country:
Passport Number:
Date of Birth:
Order Number:
(Given to you when confirming your order by fax or email.)

I, hereby authorize Posh Designs to debit the sum of

US$ from my credit card below
Credit Card AMERICAN EXPRESS
MASTER CARD
VISA
Card Number:
Valid Until: Month:  Year:
For American Express,
please mention the four digit number appearing on the center right hand corner.
For Visa Card,
please mention the three digit number appearing on the back side of the card.
Signature as on Card ____________________________________________
 

PLEASE FAX OR MAIL THIS FORM TO:
Posh Designs
33 S.M. Grande, Sukhumvit Soi 4
Bangkok 10110
THAILAND

Tel :
+66 2 656 4568, +66 2 656 4569
Fax:
+66 2 656 9055

  Payments can also be made by Bank/Postal Cheques made payable to "Posh Designs"

You can also remit money (SWIFT/TT) to our bank account. To do so please send us an email/fax to ask for our account number.