CREDIT CARD AUTHORIZATION FORM

 

I _______________________ authorize Cardservice International to charge my credit card for $_______.  I understand this is a final non-disputable transaction.

 

 

Description of product(s) purchased:

 

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Price:                                            $ ______

Shipping + Handling:                     $ _-0-__

Tax:                                              $ ______

Total:                                            $ ______

 

Credit Card #  ____________________________________

 

Expiration Date:  _________________________________

 

X  ___________________________     Date:  __________

     Authorization Signer

 

Exact Name Printed On Card:  _____________________________

                                                ____________________________

 

Please Sign and Fax Back Attn:

Charles "Chuck" Taylor

281-445-7257

CardService International
450 N. Sam Houston Pkwy., Ste.273
Houston, TX. 77060