510 818 9388
(
0
)
(
0
)
SIGN IN
BECOME A DEALER
DINING
All DINING
Dining Chairs
Tables & Benches
Bar & Counter Stools
Buffets & Wine Racks
LIVING
All LIVING
Occasional Tables
Ottomans & Cubes
Media Stands
Bookcases & Cabinets
Home Office
ACCENT
All ACCENT
Accent Chairs
Chests & Cabinets
Benches
Room Dividers
Home Decor
BEDROOM
All BEDROOM
Beds & Storages
NEW ITEMS
All NEW ITEMS
Dining
Living
Accent
Bedroom
CLOSEOUTS
Credit Card Authorization Form
Home
>
DOWNLOADS
>
Credit Card Authorization Form
Download PDF
New Pacific Direct, Inc.
7411 Central Avenue, Suite B, Newark, CA 94560
Tel: (510) 818.9388 Fax: (510) 818.9389 E-mail: info@newpacificdirect.com
Credit Card Authorization Form
Date:
* From:
(Company Name)
Re:Payment for Sales Order#:
l, *
authorize
New Pacific Direct,Inc.
to charge the amount of *
on the credit card as follows;
*
Credit Card number:
*
Expiration Date:
*
Card identification:
(3 digit)
*
Cardholder Name:
*
U.S. Billing Address1:
U.S. Billing Address2:
*
U.S. Billing City:
*
U.S. Billing State:
*
U.S. Billing Zip Code:
* Card Type:
VISA
MASTERCARD
* Save for future purchases:
Yes
No
*
Cardholder's Signature
