Credit Card Authorization Form

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					            Credit Card Authorization Form

Date: _____________________

I, ______________________________ of ____________________________,
         (NAME OF CARDHOLDER)                     (NAME OF COMPANY)


do hereby authorize Lummus Supply Co. to charge my credit card in the
amount

of $_______________ for payment of invoice number(s)_________________

______________________________________________________________.


Credit card type: ____________________________________

Credit card account # ________________________________

Credit Card V-code# ________________________________

Expiration date: _____________________________________


Please print the card holders name, credit card billing address, phone
number, email address and sign below:

__________________________________________________

__________________________________________________

__________________________________________________

Phone # (    ) ______-_______

Card member acknowledges receipt of goods and/or services in the
amount of the total shown above and agrees to perform the obligations set
forth by the card member’s agreement with the issuer.

Signature X ________________________________________

   PLEASE FAX THIS FORM TO LUMMUS SUPPLY AT 404-794-4519.