CREDIT CARD PROCESSING APPLICATION
Customer Information Credit Card Billing Address
Company Name Card Holder’s Name
City, State, Zip City, State, Zip
Phone Fax Phone Fax
Credit Card Information
Card Type Customer Code
Visa Mastercard Discover
Card Number Expiration Date Security Code
I wish to receive my credit card receipt via
E-mail Fax Mail
E-mail Address Fax Mailing Address
Terms and Conditions
1. Payment terms are net fifteen (15) days from the date of the invoice. Payments authorized after fifteen (15)
days will be subject to a three (3%) percent late charge. Payments authorized after thirty one (31) days will
be subject to a three (3%) percent late charge and one and one half (1-1/2 %) percent finance charge per
2. Payment authorization must be made in writing via fax (513.458.4304), email (email@example.com)
or through Endeavor Electric’s web site authorization form (www.endeavorelectric.com). Payment
Authorizations must contain Customer’s business name, authorizing person’s name, credit card type, last
four digits of the credit card number, Endeavor Electric’s invoice number and invoice amount.
3. Customer agrees to update Endeavor Electric of any changes to aforementioned information in writing by
re-submitting this form (i.e. address change, credit card information, etc.).
4. Sales tax will be charged unless a properly executed Sales Tax Exemption Certificate is filed with
Endeavor Electric prior to services.
5. Any claims for shortage or deductions for erroneous charges must be made within fourteen (14) days after
receipt of goods or services.
6. If default is made in payment of any sums due to Endeavor Electric and collection is made through an
attorney or collection agency, the customer agrees to pay all reasonable and necessary attorney fees,
collection agency fees, expenses and court costs.
7. Customer hereby certifies that all information provided is true and accurate. In return for such extension of
credit and credit card processing, Customer hereby agrees to all of the foregoing terms and conditions,
intending to be legally bound hereby.
Applicant’s Authorized Signature
5291 Lester Road · Cincinnati, Ohio 45213 · tele 513.458.4300 · fax 513.458.4304