CREDIT CARD AUTHORIZATION FORM
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Date: |
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Name of Credit Card Holder: |
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Company Name: |
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Phone: |
Fax: |
Email: |
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Card Billing Address:
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Shipping Address: |
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Visa______MasterCard______American Express______Discover______ |
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Credit Card #: |
Expiration date: |
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Products to Purchase:
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In order to avoid fraudulent transaction and unauthorized use of credit card, please verify the information listed above and to authorize this transaction by signing below. Thank you. |
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Authorized by: |
Date: |
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(Credit Card Holder Signature) |
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Please fax this Form back to Atlantic ComputerTech, Inc. at (718) 232-3981