CREDIT CARD AUTHORIZATION

CREDIT CARD AUTHORIZATION FORM

I hereby authorize Elite Wheel Distributor Inc and/or Elite Wheel Warehouse Miami and /or Elite Wheel and Tire Atl Inc. to charge the credit card above as a payment for goods received. This authority will remain in effect until Elite Wheel Distributor Inc and/or Elite Wheel Warehouse Miami and /or Elite Wheel and Tire Atl Inc. are notified by me.
Part I - Customer information
Customer Name:

Address :

Signature:
[signature signature-157]
Date:

Name:

Phone number:

Part II -Credit Card information
Type of credit card :

Credit Car # :

Expiration :

CVV/Security code:

I am the authorized signer of the credit card above and I authorized Elite Wheel Warehouse to charge my credit card for the amount shown above. By signing this form, I also acknowledge that all information given by me is true and accurate. Credit card fraud is a felony and is punishable by law.

Authorized Cardholder’s Signature:
[signature signature-156]
Date:

Authorized Cardholder’s Name:





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