Credit Card

Payment Form


Information Requested (En Español Tambien)    
SMSS Order# / Orden#: >>  
Order Total from Invoice / Total de Orden:    
Date / Fecha: >>  
Card Type (VISA, MasterCard or DISCOVER) / Tarjeta de Crédito: >>  
Name as it Appears on Credit Card / Su Nombre come del Tarjeta de Crédito: >>  
Credit Card Billing Address / Dirección de Cuenta: >>  
Credit Card Number (Please Input as follows: 9999 9999 9999 9999) / Número de Tarjeta de Crédito: >>  
Card Expiration Date (mm/yy) / Fecha de Vencimiento: >>  
CV Code (See Back of Card) / Código de Tarjeta de Crédito: >>  
Merchandise Ship to Address (If Same as CCard Billing Address, List as "SAME") / Domicillio que Recibir Despachar: >>  
Phone Number / Número de Teléfono: >>  
Special Instructions / Instrucciones Especial: >>  
smss credit card order info form rev. 08/05/09    

R e c e i p t     f o r     C r e d i t     C a r d     P a y m e n t

Thank You!!!

Please Copy This Portion Along with Form Above, for as Your Return Receipt.  For Office Use -- Do Not Write in This Space.

Name / Nombre: >>  
Date / Fecha:    
Order#: / Orden #:    
Amount Received / Cantidad que Recibo:    
Payment Method / Método para Pagar    
Estimated Order Ship Date / Fecha Aproximado de Mandar:    
Thanks / Gracious: >>  
smss credit card order info form rev. 08/05/09    


Cut & paste the form above into your email.  Fill out the fields to the right and send to The Sock Man Socks & Shoes at  Please Be Sure to INCLUDE ORDER TOTAL AND ORDER NUMBER.


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