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Top Shelf Comics
Credit card information form
When completed please fax to Top Shelf Comics (call for fax number)

or the information may be phoned in at 207/947-4939 during business hours

Used for the purpose of ordering from Top Shelf Comics

Information about credit/debit card being used:

Name of Cardholder: (As it appears on the card)

Billing Address of credit card:

(Exactly as in appears on your statement)
City                                  State                   .
Zip                                  .
telephone number      (        )                                     .
            night time(        )                                     .
fax number            (        )                                     .
e-mail                                                               .
Type of card: (cirle one)

visa     mc     discover

card number:                                                         .
expiration date:        .
CVV2 number:         .
cvv2 number is located on back of the card

Please note: We can only ship to the billing address of the card.

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