CREDIT CARD HOLDER'S AUTHORIZATION TO CHARGE CREDIT CARD 2008

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CREDIT CARD HOLDER'S AUTHORIZATION TO CHARGE CREDIT CARD 2008 Powered By Docstoc
					                                                               2008
           CREDIT CARD HOLDER’S AUTHORIZATION TO CHARGE CREDIT CARD
Bill To:
Team Name:                                            Credit Card Billing Address:
Contact:                                              Contact:
Street Address:                                       Street Address:
City:                                                 City:
State:                  Zip:                          State:                              Zip:
Phone:                                                Phone:
Fax:                                                  Fax:
E-mail:                                               E-mail:

Please initial and date next to all charges that you authorize:                           Initial            Date

❏ Deposit (approximately 50%) of custom order
  in the amount of: $ __________                                                         ______           ___/___/___

❏ Balance of custom order in the amount of: $ __________ + freight                       ______           ___/___/___

❏ Squadra gear inline order in the amount of: $ __________+ freight                      ______           ___/___/___

❏ Squadra fit sample order in the amount of: $ __________ + freight                      ______           ___/___/___


  By signing below , I acknowledge the charges described hereon. Payment is to be made in full
  when billed in extended payments in accordance with the standard policy of the company
  issuing the card.

  In lieu of my credit card imprint, I______________________ hereby authorize Squadra Inc. to
  charge my credit card. Please choose card and fill out the information below.



           Card Number
           Expiration                         Credit Card Verification Number:
                                                        (CCV Last 3 digits found in your signature box)
           Name on Card
           Signature                                                                         Date


Please complete this form and fax it to Squadra Inc. at 760-431-4767. This form must be
completed in full including signature, date, and CCV. All information must be true and correct in
order for the order to be processed. Please print clearly as illegible forms can not be processed.
Thank you.


                                                                    5900 Sea Lion Place #140 • Carlsbad, CA 92010
                                                                         phone: 760•431-0870 • fax: 760-431-4767
                                                                                 info@squadra.us • www.squadra.us