Equipment Exchange
Resource Systems, Inc.
8836 Washington Blvd. Unit #206
Jessup, Md 20794
Phone:301-362-9823 Fax:301-362-9826
Credit Card Payment Authorization Form
Credit card goes here
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Place your credit card in the square above and make a photocopy of this form. Fill out the information below and fax it to us at 301-362-9826
I
____________________________________________
authorize
Equipment Exchange
Resource Systems, Inc.
Charge my
Visa
Master Card
American Express
Diners Club
Number# __________________________________________ Exp. Date _____________________________
Shipping Address:
Auction number :
Phone Number:
Auction Site
Ebay
Yahoo
Amazon
Item Description
:
Item price
$
Shipping
$
Tax
$
Sub Total
$
3% Credit card fee
$
Total
$
_______________________________________________
_________________________
Signature
Date