Credit Card Form - Telewave, Inc printable pdf download

CREDIT CARD FORM

Company Name: ____________________________________________Telewave Account #: ___________________________

I ____________________________ authorize Telewave, Inc to charge my credit card

(Credit Card User Full Name)

account indicated below for _____________ on or after ___________________. This payment is for

(amount)

(date)

_____________________________________.

(Invoice #, Quote # or Purchase Order #)

Credit Card Information:

Type of Credit Card: _____Visa

_____MasterCard

_____American Express

Credit Card #: __________________________________________________________________________________________

Expiration Date: _______________________________

SEC: _______________

Name on Credit Card: ______________________________________________________________

Credit Card Billing Address: _______________________________________________________________________________

City: _________________________________________________ State/Province: ___________________________________

Zip/Postal Code: _______________________________________ Country: _________________________________________

Phone: _______________________________________________

_____Charge this credit card one time per requested above.

_____Charge this credit card one time and keep on file for future purchases.

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined

above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for

one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card

company; so long as the transaction corresponds to the terms indicated in this form.

Signature: ___________________________________________

Date: _________________________________________

Please return document to:

Telewave, Inc.- Accounts Receivable

660 Giguere Court San Jose, CA 95133

Phone:.408.929.4400, 800.626.4480 Fax: 408-929-4007

Email:

Telewave, Inc. 660 Giguere Court San Jose, CA 95133

Credit Card Form - Telewave, Inc