📄 Extracted Text (115 words)
artefacto
II III
Credit Card Holder's Authorization
October 23, 2018
hereby authorize artefacto to charge my credit
card as follows:
Visa Master Card Amex
• Number it :
• Expiration Date:
• Security code:
• In the amount of: $ 2,613.63
• For Sales Order II: PO 106861/55 and 106811/55
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
19 9 15 Biscayne Blvd. Avenluro, FL 33180
Phone: Fax:
EFTA00521202
ℹ️ Document Details
SHA-256
b09da3694cf22ffef18108d9a910d0e6746967a2c26b3c1faa1c5cf8e30ffcac
Bates Number
EFTA00521202
Dataset
DataSet-9
Document Type
document
Pages
1
Comments 0