CREDIT CARD CHARGE AUTHORIZATION FORM

Please download or print this form to be faxed to ITL at 303-449-5274. If you fill it out before printing, do not forget to sign the form after printing.

Name of Company or Individual as it appears on credit card:

Company Name (if it does not appear on credit card):

Address the Charge Card Company has for billing:

Zip Code the Charge Card Company has for billing:

Credit Card Type (check one): Visa Mastercard Discover American Express

Credit Card Number:

Credit Card Expiration date:

Dollar Amount that ITL is authorized to bill this account for:

Name of Authorized credit card signer:

Signature:________________________________________________ Date:___________________________________________________

Use your browser to print this page. Sign and fax to ITL at 303-449-5274 !
	or
	Download this document.
	.PDF format	.DOC format	HOME