EFTA01221281.pdf

SHOWTURF CREDIT CARD AUTHORIZATION FORM Company name: L—Sir Nombre de copania Address: Direccion Colco Scro i-tor saTi Phone number: Telefono ( ri-o) (6:43,-(3S-69" Fax number: (W)9 -1 -5 2--52S Telefono de fax Credit card: VA-MEX VISA MASTERCARD Tarjeta de credito Credit card number: Numero de tarjeta Expiration date: Dia de expiracion oi pc Security code: -7009 Codigo de segurida Billing address: E_ R-I 'SF ThTisa tT Direccion donde reciben los pagos N Lir/pi-2a authorize Showturf to Charge $ 373.OO to my credit card account. Print name of card holder: Nombre en la tarjeta LA) 0 ti thcZ. Signature of card holder: firma Please send signed and completed forms to 561-732-9972 or [email protected] EFTA01221281  1365 Neptune Drive 371-A Commercial Blvd ; Boynton Beach, FL 33426 Phone: 561-732-8905 Fax: 561-732-8949 Naples, FL 34104 Phone: 888-746-8873 Fax: 877-811-9949 ShowTurf Blanch www.showturf.com Hideout GC 01 • SHOWTUPF GCM Date lime Page 2830 Brantley Blvd 05/22/2015 8:44:54 (0) 1 a Naples, FL 34117 Account No. Phone No. Esametaislo. 9999 000 000000 005861 SWp Via Purchase Order 0 MISCELLANEOUS ANN RODRIGUEZ a SaWspenwn CR QUOTE EXPIRY DATE: 06/19/2015 PARTS ESTIMATE - NOT AN INVOICE SPECIAL ORDER PARTS ARE SUBJECT TO A 25% RESTOCKING FEE. **ALL QUOTES/ESTIMATES ARE ALSO SUBJECT TO SHIPPING CHARGES.** part# Description Otv Price Amount TCA17271 HYDRAULIC PUMP 1 370.75 370.75 Subtotal: 370.75 Tax: 22.25 Authorization: TOTAL: 393.00 This is not an invoice. Do not pay from this parts estimate. EFTA01221282