Letter Of Authorization To Charge Credit Card printable pdf download

Letter Of Authorization To Charge Credit Card

Letter of Authorization to Charge Credit Card (2017)

This form must be completed in full and faxed to the following number (705) 766-0415, or

emailed to chantal@timbrmart.on.ca

I, _______________________ authorize Dorset Timber Mart to charge to the following credit

card.

Estimated value of project in

dollars:_____________________________________________________

Name exactly as it appears on card:___________________________________________

Credit Card Type:(ie. Visa, Mastercard)__________________________________

Card Number:______________________________________ Expiry Date:______CVV#_____

AIRMILES COLLECTOR # ______________________________

Billing Address:_______________________________________

____________________________________________

Shipping Address:_____________________________________

____________________________________________

Telephone:_______________ Cell:_________________ Fax:______________________

Cottage:___________________ email:________________________________________

List of authorized persons to charge to account:_________________________________

__________________________________

All payments will be automatically charged on the 15

and 30th of every month,

detailed invoices and statement will be emailed/faxed at month end. I have read and

agree to the above. To cancel this agreement, a letter must be written to that affect,

and you must get written confirmation from a Dorset Timber Mart employee that the

letter was received. Delivery policies apply.

Name (please print):________________________________________________

Signature:______________________________ Date: ____________________

How would you like your invoices sent to you, please check one:

email ___Fax ____Mail ___

Letter Of Authorization To Charge Credit Card