Payment Form

Some products sold on may be shipped through our Distribution Network. In some cases your order may be processed and fulfilled through one of these Distribution Centers. By submitting your payment you authorize to process your order and provide your information to one of our Authorized Distribution Centers that may process the payment and ship your products. If you have any questions you can call us at 1-855-242-7439 or email

Full Name as it appears on your card
Card Number
Signature - Please type your name to approve this transaction *