Payment Form

This form will allow you to update payment or contact information. Most customers pay by credit card and this needs to be updated from time to time, but you can also use this formto update your contact or address information.

The pricelist is available at www.brandx.net.

Please feel free to call us at 310 395 5500 with any questions.

First Name:
Last Name:

Address:

Email:
Telephone:

Billing Information

Card Number:
Card Expiration:
CCV:

Comments

Use this area to add any comments or questions. If you wish to authorize a single or multiple payments, or have other needs, this is the place to put that information. We will do our best to help.