404 West 15th Street
New York, New York 10011
Phone: (212) 777-1150
Fax: (646) 638-3900
AUTHORIZATION TO CHARGE CREDIT CARD
Customer’s Name: _____________________________________________________
(As It Appears On Credit Card)
Credit Card Billing Address:_____________________________________________
I hereby authorize Prince Lumber Co., Inc. to charge my credit card for purchases
ordered and received in the name of
________________________________________________________. I also agree to
perform the obligations set forth by my credit card issuer with respect to all such
purchases placed on my credit card.
Prince Lumber is hereby authorized to use to my _______________ (enter type of
card) credit card # ___________________________________, expiration date
Cardholder’s Signature ____________________________________________.