Authorization to purchase products, goods and services from ABC on a continuing basis using the credit cards described herein and the terms described below, unless otherwise instructed in writing by the credit card holder.

Type of Card Visa Mastercard American Express Home Depot
Credit Card Number
Expiration Date CVC Code (last 3 digits listed on back of card, 4 digits for amex):

Credit Card Billing Address

Street
 
City
State Zip
Phone

Requested Shipping Address

Street
 
City
State Zip
Phone

As the credit card holder, I heareby authorize receipt of merchandise at the shipping address above.

Cardholder's Signature  
Today's Date May 7, 2019  
I,   the undersigned hereby states

that the above described credit card is in my name and that I authorize its use to purchase products and services from ABC and that the total purchases cost will be priced by the United States Currency. Orders for sold goods are to be placed by representatives and employers of the above described company via telephone, fax, computer transmission, in writing or verbally to filed sales representative.

Please Complete All Required Information and Fax to: 718-375-9217

Your completion of this authorization form helps us to protect you, our valued customer, from credit card fraud. All information entered on this form will be kept strictly confidential by ABC.