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efta-efta00521203DOJ Data Set 9Other

artefacto

Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00521203
Pages
1
Persons
0
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Extracted Text (OCR)

EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
artefacto Credit Card Holder's Authorization: hereby authorize Artefacto to charge my credit card number EXP in the amount of $ for a purchase order agreement. Security Code (3 digits on back of card I Amex 4 digits on front of card) PO: DATE: 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: Signature 17651 Biscayne Blvd. Aventura, FL 33160 I Phone I Fax EFTA00521203

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