CREDIT#CARD#AUTHORIZATION#FORM · 2017. 1. 16. · Credit Card Authorization Form To make a payment...
Transcript of CREDIT#CARD#AUTHORIZATION#FORM · 2017. 1. 16. · Credit Card Authorization Form To make a payment...
Blend Hospitality & Blend Home Furnishings Billing Address 1325 Frisbie Lane Cookeville TN 38501
Telephone: 800-590-8978 Fax: 800-886-0166
To make a payment via credit card, please complete this form and transmit it back to the fax or email below. Please include a photocopy of the face and back of signed credit card.
Fax: 800-‐886-‐0166 or [email protected]
CREDIT CARD AUTHORIZATION FORM
CREDIT CARD ACCOUNT INFO
I hereby authorize Blend Home and or Blend Hospitality to charge the above credit card in the amount of $_________
To expedite future orders and payment process, I hereby authorize Blend Home and or Blend Hospitality to charge the above credit card for all future purchases unless otherwise specified verbally or wriVen on
official purchase order. If yes, iniXal ___________ If no, please check:____________
Your compleXon of this authorizaXon form helps Blend Home and or Blend Hospitality protect you, our valued customer, from credit card fraud. Blend keeps all informaXon entered on this form strictly confidenXal.
Please contact us at Blend if there are any changes to the above informaXon