 Acme Micro Systems, Inc.
44153 S. Grimmer Blvd., Fremont, CA 94538 Phone: (510) 226-6778 Fax: (510) 226-6773 |
Credit Card Authorization(Please complete the form and fax back) Card No:________________________________________________________________ Visa / M/C / Discover Exp. _____/_____ Cardholder’s Name: __________________________________________________________ Issuing Bank: ______________________________________ Bank Phone No. (On the back of the card) __________________________________ Date of purchasing: _________________ Sales Order No._____________________ Item Purchase: _________________________________________________________
Company Name: _______________________________________________________ Billing Address: _______________________________________________________________________________________________________________________________
Shipping Address (Skip if same with Billing Address): ________________________________________________________________________________________________________________________________ Billing Phone No. _________________________________ Contact Phone No._________________________________ I, _____________________(print name), authorize Acme Micro Systems to charge $_______________ on the above account. I also authorize_______________ (Optional) to pick up this order or ship to the shipping address. Any unauthorized dispute of this charge without ACME Micro System’s knowledge or approval would result in my account being placed for immediate legal action with a third party.
Signature: _______________________________ Date: _______________ *Please attach a copy of your signature appeared on the back of the credit card and the identification such as driver’s license. Thank you for your business! |
PRODUCT TERM & CONDITIONS
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