Authorization for Credit Card Use
Name on Card
Your email
Billing Address
Credit Card Type
Credit Card Number
Expiration Date
Card Identification Number
I authorize 662063 Ontario Inc. to charge the credit card provided herein. I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.
Signature
Date Print Name: Return the completed and signed form to the following: info@discountequipment.ca
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