190 Whitman Ave, Edison, NJ 08817
Phone: (732) 947-3211  Fax: (718) 732-2013
Overseas phone: International Access Code -1-732-947-3211
Overseas fax: International Access Code -1-718-732-2013

Credit Card Authorization

I, , authorize TodaysConcept.com to charge the total amount of
$ to my credit card for order number on the date of .

Card Number: Expiration Date: / CVV2 Code*:

Name on the Card:

Name of C/C Issuer: Bank Phone #:

*) The CVV2 code is a 3- or 4-digit number on the back of your card, used to verify that you have possession of the credit card you are attempting to use, and is a security feature to protect against online fraud.

Billing Address:
Bill to:
Street Address:

City:
State/Province: ZIP/Postal Code:
Country:

Shipping Address:
Ship to:
Street Address:

City:
State/Province: ZIP/Postal Code:
Country:

Privacy Policy: TodaysConcept.com does not rent, sell, or share personal information about you with other people or nonaffiliated companies except to provide products or services you've requested, when we have your permission, or under the following circumstances:

• We have a parent's permission to share the information if the purchaser is a child under age 13. Parents have the option of allowing TodaysConcept.com to collect and use their child's information without consenting to TodaysConcept.com sharing of this information with people and companies who may use this information for their own purposes;
• We respond to subpoenas, court orders, or legal process, or to establish or exercise our legal rights or defend against legal claims;
• We believe it is necessary to share information in order to investigate, prevent, or take action regarding illegal activities, suspected fraud, situations involving potential threats to the physical safety of any person, violations of TodaysConcept.com terms of use, or as otherwise required by law.

Customer Certification: I certify under penalty of perjury that all information provided above was complete before I signed this form and is true and correct. I have reviewed and accept the policies of Todays Concept as stated on their website. I understand that TodaysConcept.com reserves the right to refuse this order with or without notice due to any misleading information provided. I also realize this form should be sent by 2:00PM (Eastern Time) in order to have same day shipment.

AFTER FILLING THIS FORM, PRINT IT, SIGN IT, AND FAX TO (718) 732-2013