CRF



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Credit Card Authorization Form

>>>Note: 2.5% processing fee on all transactions

Date: ______________

Company: __________________________________

Description: __________________________

Invoice Number: ___________________________

Amount: _____________________________ (include processing fee in this section)

Amex__ _ Diner Club___ MasterCard___ Visa___

Please indicate card type: Personal _ Corporate Card_

Credit Card Number____________________________________________

Expiration Date___________ CCV_____

Name of Cardholder (please print)___________________________________

Address: _______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Signature of Cardholder __________________________________________________

(For office use only)

Date Received ___________________

Processed by ___________________

Date Credit Card was charged ___________________

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