Credit Card

Document Sample
Credit Card
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: Shipping Address (if different):

____________________________________ ___________________________________

____________________________________ ___________________________________

____________________________________ ___________________________________

____________________________________ ___________________________________

Home Ph# _______________________ Home Fax# ______________________

Business Ph# _______________________ Business Fax# ______________________

Card VISA  MC  AMX  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!


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