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AFFORDABLE AUTO SALVAGE CREDIT CARD AUTHORIZATION I___________________________________________________ hereby authorize Affordable Auto Salvage to charge my credit card as follows: *Credit card type:___________ Visa – MasterCard - Am Ex - Discover *Credit card number:_________________________________________________ *Expiration date:_____________________ *V Code:__________ (Last # digits shown on the back of your card) *Credit Card Billing Address:__________________________________________ __________________________________________________________________ *SHIPPING ADDRESS:______________________________________________ __________________________________________________________________ *Name as it paper’s on the card:________________________________________ *Work phone #:__________________ Home phone#:_______________________ ___________________________________ __________________________ *Card holder's signature *Date **** NO REFUNDS!! NO EXCEPTIONS!!*** PLEASE SEND A COPY OF YOUR CREDIT CARD AND PHOTO I.D. I hereby certify that the above statements & information are true and correct to the best of my knowledge. I also certify That I am authorized to effect charges to the above card. ***********To be completed by the salesperson*********** Amount to be charged: $_________________ U.S. Dollars Includes freight charges &/or tax if applicable. Year:_____________ Make:________________ Model:_________________________ Description of the part:____________________________________________________ Salespersons name:_______________________________________________________ |