CAROL’S ROMAN SHADES, INC.
CREDIT CARD PAYMENT FORM
TYPE: VISA / MC / ON FILE
CREDIT CARD NUMBER: ________________________________
EXPIRATION DATE: __________________ CCV: _____________
BILLING ZIP CODE ____________________
Customer Info:
Person Called: _______________________ Date: _____________
Company Name: _______________________________________
Cardholder’s Name: ____________________________________
Invoice
Amount
Notes
Total Payment