CREDIT CARD PAYMENT FORM
*A 3% credit card processing fee will be added to all orders paid with credit card.
We gladly accept Mastercard, Visa, and American Express.
Please print, scan and email it to us. For added security, you may leave the credit card digits blank and call us with them.
Organization:________________________________________________
Bill to address on statement:________________________________________________
Person placing order:________________________________________________
Name on card:________________________________________________
Credit card number:_________ - ________ - _________ - __________
Expiration date:______ / ______
CVC/3 digit code on back of card:______
Signature:________________________________________________
Does your card have a per diem/transaction limit? If so, what amount should we charge each day? $________
If this is an official purchasing card with an individual code for it, please list it. _________
Thank you for your order.
We appreciate the opportunity to serve you!