RECYCLECOMPS - TECHNOLOGY RECYCLING SPECIALISTS

RECYCLECOMPS - CREDIT CARD AUTHORIZATION





	Credit Card Authorization

All Sections Below Must Be Complete In Order To Process Your Shipment


Company Name:

Billing Address For Card:



Contact Name:

Phone Number:


THIS LETTER AUTHORIZES RECYCLECOMPS TO PLACE A CHARGE ON THE FOLLOWING CARD :

Card Type:				Account Number On Card:

Issuing Bank:				Expiration Date:

Name On Card:				Security # on back of card:

Dollar Amount:				Authorized Signature:

Date:				Customer P.O.#:




			Visa A

		PLEASE FAX A PHOTOCOPY OF FRONT AND BACK OF THE CARD to (514)221-2124

			THANK YOU FOR YOUR COOPERATION.