YACHTEZ CREDIT CARD AUTHORIZATION FORM

 

Please fill in the following information and sign in the space below as authorization for a ONE TIME charge to this credit card in the amount as identified and defined below.

 

AMOUNT OF CHARGE[+3.5%,+4% for American Express Credit Card Fee]: ________________

 

NAME [As it appears on card]:________________________________________________

 

ADDRESS [card billing address]:

 

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CHECK ONE:  

VISA_______  MASTERCARD_______  AMERICAN EXPRESS_______  OTHER______

 

EXPIRATION DATE________________________________            

                                                                 [ MM / DD / YYYY]

CID CODE [visa/MC- 3 digit number on back of card/ 4 for AMEX]_______________________

SIGNATURE BELOW IS APPROVAL BY AUTHORIZED CREDIT CARD HOLDER TO USE THE CREDIT CARD INFORMATION AS CONTAINED HEREIN FOR AUTHORIZED PAYMENT OF PURCHASES OR ANY OUTSTANDING BALANCES AUTHORIZED BY CARDHOLDER FOR PAYMENT.

 

SIGNATURE____________________________________________________________________________________________________ 

                                                              AUTHORIZED SIGNATURE                                                       DATE

We ACCEPT: VISA*, MC*, AMEX*, DISCOVERY*, BANK WIRE, CHECK, & CASH

[*for credit card use, add 3.5% to invoice total for VISA/MC/DISCOVERY, for AMERICAN EXPRESS, add 4%,

 for BANK WIRE, add $35.00 per wire transaction- [1] incoming [2] outgoing payment on client behalf]

OR FOR SIMPLICITY, USE OUR PAYPAL ACCOUNT

PAYMENT DUE UPON INVOICE RECEIPT