UNIQUE CUTLERY, INC.
7578 Presidents Drive, Suite-A         Orlando, FL 32809  USA
Phone (407) 850-2119  *  Toll Free (866) 850-2119  *  Fax (407) 850-9075
E-mail: sales@uniquecutlery.com          Website: www.uniquecutlery.com
Account Set Up Information
(Please attach a legible copy of your State Sales Tax ID)
Customer Name:	Today's Date:
Business Name:	Shipping Address:
Address:
Telephone #	Billing Address:
Cell Phone #
Fax #
E-mail:
Website:	Sales Tax ID:		State:
PRE-AUTHORIZATION FORM
I authorize UNIQUE CUTLERY, INC to keep my signature on file to charge my VISA / DISCOVER / AMEX / MASTER CARD account for every time they ship merchandise to me. I have attached a legible photocopy of my Driving License or State ID with this form. I waive any defense against this authorization from the bank and UNIQUE CUTLERY, INC.
Card Type
Bank Name		Attach a copy of your Government Issued Photo ID or Driving License here.
Credit Card #
Expiration Date:                                   CVC#
Card Holder Name
Card Holder Complete Billing Address
Card Holder Signature
Date