artefacto
Credit Card Holder's Authorization:
hereby authorize Artefacto to charge my
credit card number EXP
in the amount of $ for a purchase order agreement.
Security Code (3 digits on back of card I Amex 4 digits on front of card)
PO:
• NO CREDIT CARD CAN BE
DATE: PROCESSED WITHOUT A COPY
OF DRIVER'S LICENSE AND
CREDIT CARD FRONT I BACK
Deposit
Payment in Full
Balance
By signing below, I acknowledge the charges described hereon. Payment in full
to be made when billed or in extends payment in accordance with standard
policy of issuing card Company.
Billing Address:
Signature
17651 Biscayne Blvd. Aventura, FL 33160 I Phone I Fax
EFTA00521203