Laurel Awning Company

 

1573 Hancock Avenue, Apollo, PA  15613

      Phone 1-724-567-5689   Fax 1-724-568-3152

                                       E-MAIL  LaurelAwnings@aol.com

 

CREDIT CARD PAYMENT AUTHORIZATION

 

            To make a payment for your Awning(s) by Mastercard or Visa credit card,

simply fill out the following information and return this form to our office by mail or by fax.

We accept only Mastercard and Visa.  Sorry, we are unable to accept other cards.

 

I authorize Laurel Awning Company to charge my _____________ card in the

 

amount of $_______________________ TO PAY INVOICE#_______________

 

MY ACCOUNT NUMBER IS:________________________________________

 

MY CARD “V” CODE:_____________________________________________

 

THE EXPIRATION DATE IS:________________________________________

 

NAME:        _____________________________________________________

 

ADDRESS:_____________________________________________________

 

                     _____________________________________________________

 

SIGNATURE:_____________________________ DATE:____/____/________

     

ALL SALES ARE FINAL - NO REFUNDS