Case File
efta-efta00521203DOJ Data Set 9Otherartefacto
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00521203
Pages
1
Persons
0
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Extracted Text (OCR)
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:
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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