| Please copy and paste into any word or print and fill in areas needed, once done please email or fax to 603-679-2303
Authorization for Shipping to Different Address
To Whom it May Concern,
I ______________________ with a billing address of __________________________________________________ ( full billing address needed ) made an on-line purchase from R.A.N.DM. Discount Distributing Inc. in New Hampshire ( wwwSEACOASTLIGHTING.com ) .
The purchases were Made on . ____________________, 2007 I _________________ authorize( SEACOAST LIGHTING ) R.A.N.D.M. Discount Distributing Inc. to ship my order to ______________________________________(full name and address needed ) instead of my billing address's as shown. I assume all responsibility of payment for the order, as the ship to addressee will accept this order for myself .
Once they receive and take possession of the order with a tracking reference from shipping department. (SEACOAST LIGHTING) R.A.N.D.M. Discount Distributing Inc. will not be liable for me not taking personal possession of the order which I have placed with my credit card and billing address's.
Thank you ( sign and date )
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