EFTA00521208.pdf

PORCELANOSA' TILE / KITCHEN 1 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). Sign the form and FAX it back to-. Attn: 4. IMPORTANT- A new authorization form is needed for every charge. . authorize Porcelanosa New Jersey, (CARDHOLDERS NAME EXACTLY AS IcPEARS ON THE CARD) to charge my credit card set forth below the amount of $ .l USD. This payment will be applied to order number9a0:40 11— Card Type: VISA f MASTERCARD CIRCLE ONE Credit Card # Security Code ": iration Date:OG / I ED Billing Address: (EXACTLY AS IT APPEARS ON UR STATEMENT) City: 0(20 C,Ite-K- State: M Zip Code: I0021 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 n mber set forth above; (c) understand that these charges will be billed on my next credit card st tement; a • • ) • ree to •a the above total amount according to the card issuer agreement. SIGNATURE PRINT CARDHOLDER'S NAME *a 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 • FAX EFTA00521208  PORCELANOSA® ME/KITCHEN/BATH •• FOR YOUR SECURITY, PORCELANOSA HAS IMPLEMENTED AN ADDITIONAL FRAUD PREVENTION TOOL. OUR NEW SECURITY MEASURE REOUIRES THE ENTRY OF A "SECURITY CODE" NUMBER ON VISA, AND MASTERCARD, THIS NUMBER IS A SECURITY FEATURE FOUND ON THESE TYPES OF CARDS ISSUED SINGE 1998. BY OBTAINING THIS NUMBER, WE ARE ENSURING THE HIGHEST LEVEL OF SECURITY FOR OUR CUSTOMERS. Visa and MasterCard • 3 digits in length • On back of card. Immediately following the account number in the signature panel Account Number Security Code 1 • 4 • • 4 2 1 600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446 • PHONE • FAX EFTA00521209