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MasterCard/Visa Authorization Form
Today’s Date
Card Type:
VISA
MasterCard
Retainer
Amount:
Cardholder
Name:
Card Number:
Expiry Date:
Additional
By signing below I hereby authorize Consolidated Civil Enforcement Inc. to charge the
charges
above noted credit card for invoices incurred on this file. I agree to pay these charges
incurred
and understand that Consolidated Civil Enforcement Inc. will forward me copies of the
same marked as paid by credit card.
Card Holder
Signature:
ATTACH PHOTOCOPY OF FRONT AND BACK OF CREDIT CARD
For CCE Office Use Only
CCE File Number: ____________________________
Authorization Date: __________________________
Authorization Number: ________________________
Authorizing RM: _____________________________
CCE Invoice Payment
Invoice #: _____________
Invoice Amount: ______________
Authorization Date: ______________
Invoice #: _____________
Invoice Amount: ______________
Authorization Date: ______________
Consolidated Civil Enforcement Inc.
200 807 Manning Road N.E. Calgary, AB T2E 7M8 * Phone: (403) 262-8800 * Fax: (403) 262-8801
Toll Free Phone: (888) 262-2626 * Toll Free Fax: (888) 262-8803

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