I, , hereby authorize SupplementKingdom.com to charge my credit card account in the amount of $  

  VISA/MasterCard

Discover

American Express

Credit Card Number: 

Expiration Date:  /            Security Code: 

Credit Card Billing Address:

Street: 
               
City:      State: 
Zip Code:  -

Country: (if not US)  

Telephone:  () -

Requested Shipping Address:

Street: 
               
City:      State: 
Zip Code:  -

Country: (if not US)  

Telephone:  () -

As the credit card holder, I hereby authorize receipt of merchandise at the shipping address above and by signing below, aggree with the terms and conditions as stated on our website www.supplementkingdom.com