CREDIT CARD ORDER: ORDER ENTRY FORM

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					              CREDIT CARD ORDER ENTRY FORM
Card Type:           MasterCard                 VISA               American Express

Account Number on Card:

         Security Code:             (what’s this)


Expiration Date on Card (MM/YY):

Bank Name and 800 # on the Back of Card:

Company Name:

Cardholder Name Exactly As It Appears On The Card:


Cardholder’s signature (required for all orders over $1,000.00 to be processed)


Address of Cardholder on the Credit Card:


Card holder phone #                          Cardholder Email:



If same as above please check     - if NOT fill in below completely

Ship to Company Name:
Ship to Address:
City:                               State:             Zip:
Customer Contact Name:
Telephone Number:                            E-mail:


**Tax Exempt **        State Resale/Tax Certificate must be submitted or uploaded on website
to process this order.

Aavid is only registered and able collect taxes for customers in the following states: AL, CA,
OH, MA, TX, NM **Taxable**

Ship Instructions: Collect    Carrier                         Account #
                  Prepay & add    (note freight will be charged to credit card)


Customer’s part number:                               Mfg #
Quantity:                Unit Price: $               Total: $
(Note: prepay & add freight charges will be reflected on invoice once shipped)

Required Dock Date:                                    Notes:

				
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posted:10/4/2012
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