Credit Card Information Sheet
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1Credit Card Information Sheet
Bill to Purchase Order No.:___________________________________________________________________
Card Type:
M/C
or
Visa
or
Discover/Novus
or
AMEX
Credit Card No.: ______________________________________________________________________
Card Code: _________________ Expiration Date: __________________________________________
Cardholders Company Name: _________________________________________________________________
Card Billing Address: _________________________________________________________________
Card Billing City, State, & Zip: _______________________________________________________________
Cardholders Name: ___________________________________________________________________
Phone Number: __________________________________________________________________
Fax Number/Email: _____________________________________________________________________
Check-All Sales Signature: ________________________________________ Date:______________________
Comments: __________________________________________________________________________
_________________________________________________________________________________________
Job No.: _________________
(Billing Dept. Only) Sales Amt _________________ Frt. Charges _______________Sales Tax ____________
Total Amt ________________________________
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Parent category: Business