Fax Transmission

Please print this form from your browser, complete your credit card details in section 3 and sign and date in section 4 before faxing to us:
 
Section 1 - Fax To details:
Fax To: Snake Bite
23 Demand Avenue
Arundel QLD 4214
AUSTRALIA
Fax #: 07 5529 0877
Subject:

Credit card details from for their order from Snake Bite
Section 2 - Customer details:

Order #
Billing
Address: 		Shipping
Address:
Telephone:
Email:
Section 3 - Credit Card details:
If you have any questions regarding the processing or storage of your credit card details please read our privacy policy or feel free to contact us.

Cardholders Name:  
Type of Card:.  
Credit card number: __________ - __________ - __________ - __________
Expiration date: (mm/yy) __________ /__________    
CVV: (3 or 4 Digits) __________    
 
Section 4 - Signature:

I, , have read and understand the information on this form and by submitting the information on this page to Snake Bite. I, , am giving Snake Bite authorization to bill my credit card for my account.

Cardholders signature:   Date:  
Thank you for making your purchase from Snake Bite.
Your order will not be processed or shipped until we have received your authorization to process your credit card purchase.