Office Supply Tech | Where we have everything for your office

Credit Card Type / Tipo de Tarjeta de Credito

Amex
Discover
Master Card
Visa

Card number / Numero de tarjeta

Name on card / Nombre en la tarjeta

Expiration date / Fecha de expiracion

Card CVC / Tarjeta CVC

Credit Card Billing Address (Where you receive your credit card statements) / Dirección de facturación de la tarjeta de crédito (donde recibe los extractos bancarios)

Customer or Business Name / Nombre del cliente o negocio

Complete Address / Direccion Completa

Phone / Telefono

Fax

Email / Correo Electronico

I hereby authorize Office Supply Tech Inc. to charge / Por la presente autorizo a Office Supply Tech Inc. a cobrar

Amount($) / Monto($)

To my credit card for payment of sales order# or Invoice#
A mi tarjeta de credito por pago de Orden# o Factura#

Date / Fecha

Signature / Firma

By typing your Name below you authorize us to charge your Credit Card

Al escribir su nombre debajo usted acepta que cargemos su Tarjeta de Credito

Credit Card Authorization Form

Your form has been submitted. Thank You!

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