Visa Credit Card
AVR Communications LIMITED
8-595 Middlefield Road, Toronto, ON M1V 3S2
Tel: (416) 297-9377 Fax (416) 297-4757 Canada Toll Free Tel: 888-297-9377 Fax: 866-297-4757
Attn: Sales
Date:________________________ Cardholders Name: _____________________________
(Please print the cardholders name as it appears on the card!)
Cardholders Billing Address: ____________________________________ ____________________________________ ____________________________________ ____________________________________ Home Ph# _______________________ Business Ph# _______________________ Card VISA MC AMX
Shipping Address (if different): ___________________________________ ___________________________________ ___________________________________ ___________________________________ Home Fax# ______________________ Business Fax# ______________________ Visa Card Expiration Date: __________
Card Identification# (CID# the four digit # that appears above or below the acct#) __
__ __ __
Card# __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Required Bank Card issued by: ____________________ 800# on back: # __________________
Cardholder’s Signature: __________________________________________
Note freight charges and sales tax whenever applicable will be added! Shipping Preference: UPS Federal Express Truck Other Please charge freight to my carrier acct#: ______________________________________ Notes: ____________________________________________________________________ __________________________________________________________________________
Please return this from to Fax:416-297-4757. Thank you for the opportunity to be of service!