Booking Number: |
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Card Holder Name: |
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Please be advised that your credit card is subject to be charged in parts for the amount authorized below. |
Card Holder Billing Address: |
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State: |
Zip:
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Credit Card: (Check one) |
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American Express |
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Discover |
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Visa |
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Master Card |
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Dinners |
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Credit Card Number: |
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Credit Card Expires: (mm/yy) |
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| Contact Information: |
| Day Time Ph: |
Cellular Ph: |
| Night Time Ph: |
E-mail: |
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TOTAL PAYMENT:
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If we cannot confirm services as per quote, we will send you a new invoice/confirmation form.
If the final amount changes we will require a NEW credit card form with the adjusted amount. |
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I have read and understood the Terms and Conditions as listed on the web site. I agree to adhere to them by signing below.
Third party payments must include copies of credit card's front and back. Plus ID of the credit card holder. |
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| Card Holder's Signature: |
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Shipping Address:
Documentation is sent by FEDEX requiring a signature upon receipt. We do not ship to PO BOX addresses. |
| Company or Name: |
| Attention/ Care of: |
| Address: |
| City: |
State: |
Zip:
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| Ph number: |
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