artefacto
II III
Credit Card Holder's Authorization
October 23, 2018
hereby authorize artefacto to charge my credit
card as follows:
Visa Master Card Amex
• Number it :
• Expiration Date:
• Security code:
• In the amount of: $ 2,613.63
• For Sales Order II: PO 106861/55 and 106811/55
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
19 9 15 Biscayne Blvd. Avenluro, FL 33180
Phone: Fax:
EFTA00521202