EFTA00521210.pdf

STARK Credit Card Authorization Form hereby authorize Stark Carpet Corp. to charge my card for the amount indicated below. I understand these charges are for the payment of goods and/or services by the above referenced merchant. Account #: Invoice/Order #: Amount to be charged: Credit Card Type: Amex ❑ Visa ❑ MasterCard ❑ Credit Card #: Credit Card Expiration Date: C111/ Security Code: Company Name: Cardholder Name: Billing Address: City: State: Zip Code: Phone #: Email address for CC receipt: Terms & Conditions: The above named client understands and acknowledges the charges described above. The client agrees payment MN! is to be made when billed in accordance with the standard policy of the issuing bank and without any disputes or stop payments on the above credit card. Please sign below agreeinfil ), the above terms and conditions: Cardholder Signature: Print Name: Date: EFTA00521210