📄 Extracted Text (143 words)
STARK Credit Card Authorization Form
hereby authorize Stark Carpet Corp. to charge my card
for the amount indicated below. I understand these charges are for the payment of goods and/or
services by the above referenced merchant.
Account #:
Invoice/Order #:
Amount to be charged:
Credit Card Type: Amex ❑ Visa ❑ MasterCard ❑
Credit Card #:
Credit Card Expiration Date:
C111/ Security Code:
Company Name:
Cardholder Name:
Billing Address:
City: State: Zip Code:
Phone #:
Email address for CC receipt:
Terms & Conditions: The above named client understands and acknowledges the charges described above. The
client agrees payment MN! is to be made when billed in accordance with the standard policy of the issuing bank
and without any disputes or stop payments on the above credit card.
Please sign below agreeinfil ), the above terms and conditions:
Cardholder Signature:
Print Name: Date:
EFTA00521210
ℹ️ Document Details
SHA-256
742cb489d5d4a836e133a13064b176f8303571fb535d31a38a90e1bd1017e656
Bates Number
EFTA00521210
Dataset
DataSet-9
Document Type
document
Pages
1
Comments 0