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Credit Card Payment Authorization Form
Name:
_______________________
authorizes Simplicity Marine Products, Inc.
to charge the following credit card for purchases made from Simplicity Marine
Products, Inc.
Credit Card Type: Visa MasterCard
Account No: ________________________________________
3 numbers code on back of card ________________________
Expiration Date: ______/______
Name on Credit Card: ________________________________
Billing Address for Card: ______________________________
City
________________________ State __________________
Country______________ Postal Code __________________
Phone # __________________________
____________________
Sale Amount approved: $___________USD
plus shipping and 3% paperwork & processing fee will be added
Signature: ________________________________ Date ___________
On
international purchases please send copy of Pass Port or Drivers License and
copy of Credit Card front and back.
E-mail or Fax completed form and copy of Pass Port, drivers
license and
front and back of Credit Card to Fax 727-499-7457
OR email alan@simplicity-marine.com
On Behalf of the Simplicity Products Team, We Appreciate your
Business and Look
Forward to Helping you with your needs in the future.
