Gavin Scooters,
Inc.
318 Indian Trace Rd #513 Weston, FL 33326
fax: (954 385-3728)
For further assistance: 954
328-2611
CREDIT CARD AUTHORIZATION
Please complete the information
below exactly as it appears on your credit card billing
statement.
THIS LETTER IS TO AUTHORIZE
GAVIN SCOOTERS TO USE THE FOLLOWING CREDIT CARD(S).
CARDHOLDER
NAME:_______________________________________________________
ADDRESS:____________________________________________________
_____________________________________________________________
COUNTRY:__________________________________________________
PHONE
NUMBER-HOME:______________________________________________________
OTHER:_____________________________________________________
FAX:______________________________________________________
CREDIT CARD TYPE:
M/CARD______ VISA______AMEX______ DISC________
CREDIT CARD NUMBER:
_____________________________________________________
EXPIRATION DATE:_______________ NAME OF
BANK:___________________________
I HEREBY AUTHORIZE
GAVIN SCOOTERS TO USE THE ABOVE CARD(S) FOR PAYMENT OF BALANCE
DUE:
$______________________________
SIGNED BY
CARDHOLDER:__________________________________
DATE:___________
FORM MUST BE COMPLETED IN FULL, SIGNED
BY AN AUTHORIZED USER OF THE CREDIT CARD, FAXED AND/OR MAILED AND
RECEIVED BY GAVIN SCOOTERS, PRIOR TO SHIPMENT OF ITEM(S).
RETURN FORM BY FAX TO (954) 385-3728 OR
MAIL TO ADDRESS LISTED ABOVE.
