Credit Card Authorization Form

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					Credit Card Charge Authorization Form
I (we) hereby authorize BRIGHTVIEW WINDOW & DOOR DISTRIBUTION INC. to make charges to my
Credit Card listed below, and, if necessary, initiate adjustments for any transactions credited/debited in error.

Subject to the ACKNOWLEDGMENT set forth below this authority will remain in effect until
BRIGHTVIEW WINDOW & DOOR DISTRIBUTION INC. is notified by me (us) in writing to cancel it in
such time as to afford BRIGHTVIEW WINDOW & DOOR DISTRIBUTION INC. and Credit Card
company a reasonable opportunity to act on it.



(Name - PLEASE PRINT AS APPEARS ON CARD)

____________________________________________________________________________________
Relationship to Purchaser and Guarantor


(Address - PLEASE PRINT)


(Phone Number - PLEASE PRINT)


(Email - PLEASE PRINT)

Please circle one: Visa / MasterCard / Amex

Account Number:_________________________________________________

Expiration Date:_____________________                       Three Digit Code from back of card:__________

Charge Amount: Any amount that remains unpaid for a period of more than ninety (90) days
from date of purchase.

                                          ACKNOWLEDGMENT

I ACKNOWLEDGE THAT THIS AUTHORIZATION SHALL REMAIN IN FULL FORCE AND
EFFECT UNTIL ALL PURCHASES MADE BY SELLER TO PURCHASER ARE PAID IN FULL. I
ACKNOWLEDGE THAT I AM AWARE THAT IN THE EVENT OF NONPAYMENT BY
PURCHASER, PURCHASER’S AND/OR GUARANTOR’S CREDIT CARD ACCOUNT WILL BE
CHARGED.



(Signature)                                                                  (Date)


______________________________________________________
(Print Name)

				
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posted:10/4/2012
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