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Credit_Debit_Card_Payment

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Credit_Debit_Card_Payment Powered By Docstoc
					                                                       CREDIT / DEBIT CARD PAYMENT FORM


NAME OF ISSUING BANK:                         _____________________________________________________


CARD NUMBER:                                  _____________________________________________________


EXPIRY DATE:                                  __________________________


SECURITY NUMBER:                              __________________________
(As shown on back of card)

NAME & ADDRESS OF CARDHOLDER: _______________________________________________

                                                         _______________________________________________

                                                         _______________________________________________

                                                         _______________________________________________



    I authorise Edge Distributions to debit my nominated
      card account for on going orders with trade sales:

CARDHOLDERS SIGNATURE:                                 ________________________________________________


DATE:                                                  _________________________



 Completed forms should be faxed to Credit Control on 0871 900 55 66 together with a
              clear photocopy of the front and back of the credit card.



EDGE ACCOUNT NUMBER:                          __________________________
(Internal use only)




Edge Distributions, Unit A2 Charles House, Southall, Middlesex, UB2 4BD, United Kingdom
Tel: +44 (0) 20 8843 2200 Fax: +44 (0) 871 900 5566 E-Mail: sales@edgedistributions.co.uk

				
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