artefacto

artefacto 11 111 Credit Card Holder's Authorization November 20,2015 hereby authorize artefacto to charge my credit card as follows: • Visa Master Card Amex • Number # : • Expiration Date: • Security code: • In the amount of: $ • For Sales Order #: IMPORTANT NOTE: PLEASE ATTACH A COPY OF YOUR DRIVER'S LICENSE. By signing below, I acknowledge the charges described here on. Payment in full to be made when billed or in extended payment in accordance with standard policy of issuing card Company. Name as it Appears on Card: Billing Address: City: State: Zip: Signature Date 1 9 9 1 5 Biscayne Blvd. Avent ine, FL 3 3 1 8 0 Phone: Fax: EFTA00521201