Credit Card - Credit Card Payment Slip Template by Biscuit350

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									                                   State of Alabama
                            Office of the Secretary of State
                          Uniform Commercial Code Division
                                    (334) 242-5231
                                 Fax (334) 353-8269
Mailing Address                                                       Physical Address
Post Office Box 5616                                                  11 S. Union St. Ste. 200
Montgomery, Alabama 36103-5616                                        Montgomery, AL 36104




                         Credit Card Payment Slip
Card Type..: ______________________ (Visa, MasterCard, Discover, &American Express)

Card Number: _________________________

Exp Mo/Yr: ___ / ___

Card Holder: ______________________________________

Billing Address:    ________________________________________

City/St/Zip: _________________, _____ _______-______

Signature of Card Holder: X______________________________
                                    Must be original signature of Cardholder

								
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