Credit Card Transaction Report

 

Company Name:_________________________________________________________

 

Buyers Name:___________________________________________________________

                                                                (Exactly as it appears on the card)

 

Address:_______________________________________________________________

 

City:____________________________   State: ________________Zip:_____________

 

 

Credit Card Type:  Visa: ________     Mastercard:  ________    Amex: ________

 

Credit Card Number ____________ - _____________ - __________-__________

 

Expiration Date:_________________

 

                                                            Transaction Details:

                                    Materials Subtotal:                    $______________

 

                                    Applicable Sales Tax:               $______________

 

                                    Estimated Freight:                     $______________

 

                                    Estimated Order Total:  $______________

 

Card Holders Signature:______________________________________________

 

Note: This form must be signed by the card holder and returned to us

before your order can be processed for shipment.

 

*Please Note:  All returns, cancellations, or charge orders may be subject to a restocking charge.

 

*Return authorization is required prior to any and all return(s).

 

Customer ____ Does  ____ Does not

want an invoice to be sent to him/her

 

1312 East Avenue N, Sarasota, Fl  34237   (941) 955 2050    Fax  (941) 955 2051

1-888-251-2050                                                                                                                                           www.seacurity.com