📄 Extracted Text (117 words)
artefacto
11 111
Credit Card Holder's Authorization
November 20,2015
hereby authorize artefacto to charge my credit
card as follows:
• Visa Master Card Amex
• Number # :
• Expiration Date:
• Security code:
• In the amount of: $
• For Sales Order #:
IMPORTANT NOTE: PLEASE ATTACH A COPY OF YOUR DRIVER'S LICENSE.
By signing below, I acknowledge the charges described here on. Payment in full
to be made when billed or in extended payment in accordance with standard
policy of issuing card Company.
Name as it Appears on Card:
Billing Address:
City:
State:
Zip:
Signature Date
1 9 9 1 5 Biscayne Blvd. Avent ine, FL 3 3 1 8 0
Phone: Fax:
EFTA00521201
ℹ️ Document Details
SHA-256
2a3eb3087ec748d1e2cc4dbe8f4e04eb0700ca21d3f92e84fbc8fc7df2788a9a
Bates Number
EFTA00521201
Dataset
DataSet-9
Document Type
document
Pages
1
Comments 0