Professional Fax - New Direx
239 Laurel Road, East Northport NY 11731Tel: 631-837-0100 Fax: 631-837-0105NEW DIREX, INC.CREDIT CARD PAYMENTS (3.5% FEE / $25 MIN)See the attached statement totaling $________ inv# ______________________Amount you are paying __________ + fee ____________ = Total ___________Please provide the following information from your credit card:Credit Card Number _______________________________________________Please circle - Visa Master Card Discover American ExpressExpiration Date__________________3 or 4 digit code on back of card ______________Name on Card___________________________________Billing Address _______________________________ _______________________________WIRE TRANSFER INFOChase Bank35 Indian Head RdKings Park, NY 11754ABI# 021 000021ACCT# 6901157039Swift Code: Chasus 33Name: New Direx, Inc. ................
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