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Kangaroo Inflatables Credit Card Authorization Form

Company Name ___________________________________


Contact Person ____________________________________


Company Address ________________________


City____________State _______Zip_____


Shipping Address _________________________


City_____________State _______Zip_____


Business Phone __________________________________


Fax Number ______________________________________


E-mail Address ____________________________________


Company Web Site _________________________________


I hereby Authorize Kangaroo Inflatables to Charge the

credit card listed below On Date _________ for the amount of


$___________ to start production on the unit(s) ordered.

For Invoice number __________

I understand production will not begin until the credit card is charged.


I here by authorize Kangaroo Inflatables to Within 48 hours

prior to shipment of the products ordered to charge the


Credit Card indicated below for the full remaining balance

amount of $___________


I _(Name)__________________________________have read

and accept Kangaroo Inflatables terms and conditions.


Check One


Visa ___ Master Card ___ American Express ___ Discover ___


Credit Card Information


Card # ____________________________


Card holder name ___________________________________


Expiration date Month ______Year _____


Code on back of Credit card _______________


Credit Card Billing Address ______________________


City___________State ____Zip________


Drivers License # _______________________


Authorization Signature: _________________________________


Print your First __________________ Last Name_________________


Date ________


If Shipping address and Billing address are not the same,

Please provide a copy of the credit card (front and back) and your driver license


 All Inflatables Ship With

  • Blower
  • Tarp
  • Business Banner
  • Patch Kit
  • Stakes
  • Tie down straps
  • Owners Manual

All Inflatables Include

  • Entry Ramp
  • Deflation Zipper
  • Business Card holder
  • Emergency exit
  • Warning Sign

All Inflatables are

  • Made in USA
  • Made with 18.5 oz Vinyl
  • Double and Quadruple Stitched
  • Color can be Customized