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CREDIT CARD AUTHORIZATION
1. Order # _____________________ 2. Company Name ____________________________________ 3. Credit Card Information
Please check one of the following: _____ VISA _____ MasterCard _____ AMEX
Credit Card # _________________________________________
Expiration Date ______________________ CVV
3- or 4-Digit # (located on the back of your card on the signature line)
________ 4. Print name as it appears on the card
_______________________________________________ Authorized signature
________________________________________________________ Today's Date
___________________________ 5. Credit Card Billing Address _________________________________________________________ City __________________________________________ State ___________ Zip _____________ 6. Order Price _________________________________ 7. Shipping & Handling _________________________ TOTAL CHARGE: _______________________ * Please fax this
order form to: Specialty Optics – (805) 566-2196, or
telephone us with this information – (805) 745-1690 ~ Thank you for
your order ~ Return to Order Procedure page. |
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6390 Rose Lane, Carpinteria, CA 93013 USA TEL: (805) 745-1690 / FAX: (805) 566-2196 EMAIL: sales@specialty-optics.com www.specialty-optics.com
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