EFTA00521206.pdf

PORCELANOSN" TILE / KITCI IEN / I3ATI I CREDIT CARD AUTHORIZATION FORM If you would like to charge a purchase to your Visa or MasterCard, AMEX please do the following: I . Print out the form. 2. Completely fill out the form below (Please print clearly). 3. Sign the form and FAX it back to . Attn: 4. IMPORTANT: A new authorization form is needed for every charge. authorize Porcelanosa New Jersey, (CARDHOLDERS NAME EXACTLY AS IT APPEARS ON THE CARD) to charge my credit card set forth below the amount of $ . USD. This payment will be applied to order number Card Type: VISA / MASTERCARD / AMEX (CIRCLE oNE) Credit Card #: Security Code ": Expiration Date: / Billing Address: (EXACTLY AS IT APPEARS ON YOUR STATEMENT) City: State: Zip Code: 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 number set forth above; (c) understand that these charges will be billed on my next credit card statement; and (d) agree to pay the above total amount according to the card issuer agreement. (CARD HOLDER SIGNATURE) (DATE) (PRINT CARDHOLDER'S NAME) 600 ROUTE 17 NORTH, RAMSEY. NEW JERSEY 07446 • PHONE • FAX EFTA00521206  PORCELANOSA' TILE / KITCI IEN ' BAT} I ** THE FOLLOWING PAGE LISTS THE LOCATIONS FOR THE NECESSARY CODE: CREDIT CARD AUTHORIZATION FORM SECURITY CODE LOCATIONS ** 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 digits in length • On back of cord. immediately following the account number in the signature panel Amount Number Security Code 600 ROUTE 17 NORTH, RAMSEY, NEW JERSEY 07446 • PHONE • FAX EFTA00521207