Document Sample
					                                     CREDIT CARD PROCESSING APPLICATION

                      Customer Information                                              Credit Card Billing Address
Company Name                                                         Card Holder’s Name

Address                                                              Address

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

                                                           Receipt Information
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 (
            or through Endeavor Electric’s web site authorization form ( 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
By                                                                   Title

Name                                                                 Date

                   5291 Lester Road ·       Cincinnati, Ohio 45213 · tele 513.458.4300 · fax 513.458.4304