📄 Extracted Text (175 words)
Gulfstream Aerospace Corporation
Credit Card Transaction Authorization Form
Date:
Customer Name: HYPERION AIR, INC.
Customer Number: CH200
Customer Contact Name: LARRY VISOSKI
Customer Contact Phone No.:
Customer Contact Fax Number:
Company Name on Credit Card:
Individual Name on Credit Card:
Credit Card Billing Address:
(must match address on fik with CC company)
Type of Credit Card:
Credit Card Number:
3 or 4 Digit
Credit Card Expiration Date: Security Code*
*American Express must have security code to process*
Total Amount Authorized to Charge: $_ 12,319.36
Invoices or Other References / Amounts to be paid (must list singularly):
Invoice NoJ Reference Amount Invoice No./ Reference Amount
1 8
2 9
3 10
4 11
5 12
6 13
7 14
We acknowledge that all parts returned are subjec to restocking fees and shipping charges. By
my signature, I certify that I am authorized to execute this transaction and that I agree to pay in
full all charges related to the above transaction(s).
Signature
Print Name & Title
Card Name Verification Batch .! Approval (Gulfstream Use Only)
EFTA01093390
ℹ️ Document Details
SHA-256
f2596934482f4192e4f3daac18c553fb3d22d26fe9d1cc13ba0870084fe46436
Bates Number
EFTA01093390
Dataset
DataSet-9
Document Type
document
Pages
1
Comments 0