EFTA02311056.pdf

PORCELANOSA' TILE / KITCHEN / BATH CREDIT CARD AUTHORIZATION FORM If you would like to charge a purchase to your Visa or MasterCard. AMEX please do the following: 1. Print out the form. 2. Completely fill out the form below (Please print clearly). 3. Sign the form and FAX it back to 917-289-1228. Attn: Marisa Bordonaro 4 IMPORTANT. A new authorization form is needed for every charge. I,.1.1== author' ew Jersey. d (CARDHOLDERS NAME EXACTLY AS I EARS ON THE CARD) to charge my credit card set forth below the amount of $ USD. This payment will be applied to order numbe Card Type: VISA / MASTERCARD CIRCLE ONE) Credit Card #: Security Code **: ist Expiration WM1 Billing Address:9 --sh lUl City. ay.) & rY. (EXACTLY AS IT APPEARS ON N' UR STATEMENT) State: N Zip Code: 10O2 My signature below confirms that I (a) fully acknowledge this purchase and understand the charges as set forth above; (b) have authorized Porcelanosa New Jersey, Inc. to charge the amount to the card et forth above; (c) understand that these charges will be billed on my next credit card e card issuer agreement. " THE FOLLOWING PAGE LISTS THE LOCATIONS FOR THE NECESSARY CODE CREDIT CARD AUTHORIZATION FORM SECURITY CODE LOCATIONS 600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446 • PHONE (201)995-1310 • FAX (201) 995-1960 EFTA_R1_01196403 EFTA02311056  PORCELANOSAG-t TILE / KITCHEN / BATH •• FOR YOUR SECURITY, PORCELANOSA HAS IMPLEMENTED AN ADDITIONAL FRAUD PREVENTION TOOL. OUR NEW SECURITY MEASURE REQUIRES THE ENTRY Of A "SECURITY CODE" NUMBER ON VISA, AND MASTERCARD. THIS NUMBER IS A SECURITY FEATURE FOUND ON THESE TYPES OF CARDS ISSUED SINCE 1998. BY OBTAINING THIS NUMBER, WE ARE ENSURING THE HIGHEST LEVEL OF SECURITY FOR OUR CUSTOMERS. Visa and MasterCard • 3 drytis :ri length • On ba::k cf rand. :rnnied:ately fornw.nq the accol.nt number In the signature panel 600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446 • PHONE (201)995-1310 • FAX (201)995.1960 EFTA_R1_01196404 EFTA02311057