Phone 1-724-567-5689 Fax 1-724-568-3152
E-MAIL LaurelAwnings@aol.com
PA Registration #s: PA006971 & PA007616
NJ Registration #: 13VHO5144000
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.
NAME:
________________________________________________________
ADDRESS:________________________________________________________
________________________________________________________
SIGNATURE:________________________________
DATE:____/____/________
I
authorize Laurel Awning Company to charge my MasterCard / Visa (circle one) in
the
amount of $_______________________ TO PAY INVOICE#______________
ALL SALES ARE FINAL - NO REFUNDS
-------------------------------------------------------------------------------------
MY
ACCOUNT NUMBER IS:___________________________________________
MY
SECURITY CODE (3 DIDGIT NUMBER ON BACK OF CARD) IS:___________
THE
EXPIRATION DATE OF MY CARD IS: ______/______/______
ALL SALES ARE FINAL - NO REFUNDS