artefacto
11 111
Credit Card Holder's Authorization
November 20,2015
hereby authorize artefacto to charge my credit
card as follows:
• Visa Master Card Amex
• Number # :
• Expiration Date:
• Security code:
• In the amount of: $
• For Sales Order #:
IMPORTANT NOTE: PLEASE ATTACH A COPY OF YOUR DRIVER'S LICENSE.
By signing below, I acknowledge the charges described here on. Payment in full
to be made when billed or in extended payment in accordance with standard
policy of issuing card Company.
Name as it Appears on Card:
Billing Address:
City:
State:
Zip:
Signature Date
1 9 9 1 5 Biscayne Blvd. Avent ine, FL 3 3 1 8 0
Phone: Fax:
EFTA00521201