AUTHORIZATION

I, _____________________________, hereby give verbal and written consent to charge my credit card;

(print your full name as it appears on your credit card.)

Circle One: VISA MC AMEX DISC 

 

Card Number:________________________________ Expiration Date: __________________

 

for a any and all products - phone conversations -services rendered, as well as any shipping charges, that I

have purchased from:

INTUITIONS

636 Saint Ann Street

New Orleans, LA 70116

Phone: 504-523-1063

Fax: 504-523-1063

Cell: 504-710-5487

 

MYSTIC TEA LEAVES

638 Royal Street

New Orleans, LA 70116

Phone: 504-523-1063

Fax: 504-523-1063
Cell: 504-710-5487

Signature: _________________________________   Date: __________________________

This authorization must be signed, dated and emailed to Intuitions before orders will be processed and

shipped. An original receipt for any purchaces will be sent with the order via UPS, unless another carrier

is requested by the card holder. 

SHIPPING ADDRESS:

 

__________________

__________________

__________________

ALTERNATE CARRIER (optional)

 

__________________

Intuitions thanks you for your business.