CREDIT CARD PAYMENT

AUTHORIZATION
Need to Pay by Credit Card?

Name On Card*
Amount of $*
Billing Address*
City*
State*
Zip*
Email*
Phone*
Date*
Signature*
*
- I authorize, as indicated by my signature, Custom Tents and Tarps, LLC to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services and for the amount discussed only, and is valid for one time use only (unless indicated otherwise). I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; as long as the transaction corresponds to the terms indicated in this form.