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Credit card authorizing form
Credit Card Use Authorization



Date:_______________________



To: NOVA COMPUTERS



From: ____________________________________



Dear Merchant:

I am in receipt of the invoice order and acknowledge the description of the merchandise/services.

I recognize and confirm the total charge in the amount of



_______________________________________________ US Dollars

I hereby authorize use of my credit card #

__________________________________________


American Express __ Mastercard __ Visa __ Expr Date: ___/____ Security Code_____

For payment of said merchandise/services.

I agree to pay the amount show above as it appears on invoice order #_________________(please enter the last 4 digits of the order number)

Card Holder Name (Print) ___________________________



Card Holder Signature: ______________________________

Billing Address: ________________________________________________________________

Phone #: ______________________________________________________________________

Shipping Address: ______________________________________________________________



Driver License #:____________________________ State:____________

Please fill out the form, Sign and obtain notary public certification (at your bank or similar Public Notarizer) and fax to 1-206-600-4293 Attn: Sales Department