CREDIT CARD CHARGE AUTHORIZATION FORM

Please download or print this form to be faxed to ITL at 970-535-3114. 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:

ITL is authorized to charge this account up to, but not to exceed $

Name of Authorized credit card signer:

Signature:________________________________________________ Date:___________________________________________________

PLEASE FAX THIS FORM TO ITL AT: (970)535-3114 WHILE ITL UTILIZES VIRUS SCAN AND ANTI-HACKER SOFTWARE, SHOULD CUSTOMER DECIDE TO E-MAIL THIS FORM TO ITL, THEY ARE DOING SO AT THEIR OWN RISK. FAXING CREDIT CARD INFORMATION IS ALWAYS SAFER.

Use your browser to print this page. Sign and fax to ITL at 970-535-3114 !
	or
	Download this document.
	.PDF format	.DOC format	HOME