Made for a Queen :: Custom Made Rhinestone Jewelry

Credit Card sale information/authorization form
For ALL purchases made via internet or telephone to madeforaqueen.com (Holliday's Headliners) complete this form, make a photo copy of both the front and back of your Drivers License (or state id) and the credit card you wish to use, fax to (520) 327-1576.

Name: (As it appears on Credit Card)
Check One: MasterCard Visa Discover Card Number:
Expiration Date:
3 Digit Verification Code: (located on the Signature panel of your card)
I authorize Holliday's Headliners to charge my credit card per order.
Signature:
Date:
Credit Card Billing & Confirmation Mailing Address
Name:
Address:
City:
State:
Zip:
Daytime Phone Contact:
Email:

Certified checks or postal money orders should be made payable to Holliday's Headliners.	Send Certified Checks/Postal Money Orders to: Holliday's Headliners 4401 E. Mesquite Desert Trail Tucson, Arizona 85706