Case File
efta-efta00520750DOJ Data Set 9OtherCredit Card Holder's Authorization:
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00520750
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Credit Card Holder's Authorization:
credit card number
in the amount of $ -916 6 ‘
for a purchase order agreement.
Security Code
03 digits on back of card I Amex 4 digits on front of card)
PO:
Deposit
Payment in Full
Balance
• NO CREDIT CARD CAN BE
PROCESSED WITHOUT A COPY
OF DRIVER'S LICENSE AND
CREDIT CARD FRONT I BACK
By signing below, I acknowledge the charges described hereon. Payment in full
to be made when billed or in extends payment in accordance with standard
policy of issuing card Company.
Billing Address:
9 E. 726/ 11/2 -ae
New yeti/ fr/
/was/
I Fax
17651 Biscayne Blvd. Aventura, FL 33160 I Phone
EFTA00520750
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