Visa/MasterCard/American Express Credit Card Authorization Contract I (Cardholder/Owner) ________________________________________________________________authorize Silver City Serpentarium, Inc. to utilize the following credit card for present and future purchases made by my myself and/or by someone working for or associated with my company. This includes allowing others (partners, employees, etc., ...) to sign any necessary receipt forms from the carrier for these purchases. Name of Business and/or Cardholder: __________________________________________________________________________________ Cardholder's name as it appears on the credit card: _______________________________________________________________________ Credit Card Billing/Shipping Address (Including Zip Code): _________________________________________________________________ Alternate Authorized Shipping Address: ________________________________________________________________________________ ________________________________________________________________________________________________________________ Credit Card Number (Include 3 digit V-Code from Back of Card): ______________________________________________________________ ________________________________________________________________________________________________________________ Credit Card Expiration Date: _________________________________________________________________________________________ Telephone Number(s): ______________________________________________________________________________________________ Terms and Conditions of Sale
*Please notify us of weather conditions in your area so we may pack your shipment(s) accordingly. Cardholder's Signature___________________________________________ |