Secure Form for the Century Collection

ATTENTION: DO NOT HIT THE "ENTER" KEY WHEN FILLING IN THIS FORM. IF YOU DO, YOU WILL HAVE TO START OVER AGAIN. TO MOVE FROM SPACE TO SPACE, USE THE "TAB" KEY, "ARROW" KEYS, OR THE "MOUSE" (CURSOR).

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For Security Reasons, the Credit Card Processing Center now REQUIRES that the Credit Card Billing Address (the address where your credit card bill is sent) and the associated Zip Code must match the information on file at your Credit Card Company. IMPORTANT NOTE: If your Billing Address DOES NOT MATCH the information on file with your credit card company and the charge is APPROVED, you WILL BE CHARGED an additional $1.75 for Credit Card Fraud Insurance. This is the charge that the credit card company now charges me when the information YOU submit does not match the information in their files.

PROVIDE ALL OF THE FOLLOWING INFORMATION!!

Billing Address (where your credit card company sends you their monthly statement)
.... Name
.... Email Address
.... Email Address (again)
.... Mailing Address
.... City
.... State
.... Zip Code
.... Country
.... Phone Number
.... FAX Number (not required)

Shipping Address - ONLY NEEDED IF Different from the information above.
.... Name
.... Email Address
.... Email Address (again)
.... Mailing Address
.... City
.... State
.... Zip Code
.... Country
.... Phone Number
.... FAX Number (not required)

Credit Card Information
... Card Holder's Name (A Person's Name)
... Credit Card Number (16 digits)
... Credit Card Number (again)
... Expiration Date (Example: 12/08 [mo/yr])
... Security Code (last 3 digits [on back] )

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Type 'Century Collection' in this box.

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. As per the Fair Credit Billing Act, your bank cannot hold you liable for more than $50.00 of fraudulent credit card charges. PLAYER-CARE will pay the $50.00 if the unauthorized use of your card resulted from a purchase made through our site. We are so confident of the security measures we've put in place, we'll also pay you an additional $25 just for the inconvenience!

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407 19th Ave, Brick, NJ, 08724 Phone Number 732-840-8787