EFTA02311056.pdf
dataset_11 pdf 173.1 KB • Feb 3, 2026 • 2 pages
PORCELANOSA'
TILE / KITCHEN / BATH
CREDIT CARD AUTHORIZATION FORM
If you would like to charge a purchase to your Visa or MasterCard. AMEX please do the following:
1. Print out the form.
2. Completely fill out the form below (Please print clearly).
3. Sign the form and FAX it back to 917-289-1228. Attn: Marisa Bordonaro
4 IMPORTANT. A new authorization form is needed for every charge.
I,.1.1== author' ew Jersey.
d
(CARDHOLDERS NAME EXACTLY AS I EARS ON THE CARD)
to charge my credit card set forth below the amount of $ USD.
This payment will be applied to order numbe
Card Type: VISA / MASTERCARD CIRCLE ONE)
Credit Card #:
Security Code **: ist Expiration WM1
Billing Address:9 --sh
lUl
City. ay.) & rY.
(EXACTLY AS IT APPEARS ON N' UR STATEMENT)
State: N Zip Code: 10O2
My signature below confirms that I (a) fully acknowledge this purchase and understand the charges as
set forth above; (b) have authorized Porcelanosa New Jersey, Inc. to charge the amount to the card
et forth above; (c) understand that these charges will be billed on my next credit card
e card issuer agreement.
" THE FOLLOWING PAGE LISTS THE LOCATIONS FOR THE NECESSARY CODE
CREDIT CARD AUTHORIZATION FORM
SECURITY CODE LOCATIONS
600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446 • PHONE (201)995-1310 • FAX (201) 995-1960
EFTA_R1_01196403
EFTA02311056
PORCELANOSAG-t
TILE / KITCHEN / BATH
•• FOR YOUR SECURITY, PORCELANOSA HAS IMPLEMENTED AN ADDITIONAL FRAUD PREVENTION TOOL. OUR NEW SECURITY
MEASURE REQUIRES THE ENTRY Of A "SECURITY CODE" NUMBER ON VISA, AND MASTERCARD. THIS NUMBER IS A SECURITY
FEATURE FOUND ON THESE TYPES OF CARDS ISSUED SINCE 1998. BY OBTAINING THIS NUMBER, WE ARE ENSURING THE HIGHEST
LEVEL OF SECURITY FOR OUR CUSTOMERS.
Visa and MasterCard
• 3 drytis :ri length
• On ba::k cf rand. :rnnied:ately fornw.nq the accol.nt number In
the signature panel
600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446 • PHONE (201)995-1310 • FAX (201)995.1960
EFTA_R1_01196404
EFTA02311057
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Document Metadata
- Document ID
- 099ad988-5412-42a6-8c27-5ecca10c997e
- Storage Key
- dataset_11/EFTA02311056.pdf
- Content Hash
- 32404c83e9d2383e1ce8820d171a5d24
- Created
- Feb 3, 2026