Independent testing Laboratories, Inc. (ITL) Boulder, CO. Serving the lighting industry- Photometry, Electrical testing, Lighting Software, Reflector Design, Lighting Application Engineering, Goniophotometer systems.
Independent testing Laboratories, Inc. (ITL) Boulder, CO. Serving the lighting industry- Photometry, Electrical testing, Lighting Software, Reflector Design, Lighting Application Engineering, Goniophotometer systems.

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.

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