EFTA00521203.pdf

artefacto Credit Card Holder's Authorization: hereby authorize Artefacto to charge my credit card number EXP in the amount of $ for a purchase order agreement. Security Code (3 digits on back of card I Amex 4 digits on front of card) PO: • NO CREDIT CARD CAN BE DATE: PROCESSED WITHOUT A COPY OF DRIVER'S LICENSE AND CREDIT CARD FRONT I BACK Deposit Payment in Full Balance By signing below, I acknowledge the charges described hereon. Payment in full to be made when billed or in extends payment in accordance with standard policy of issuing card Company. Billing Address: Signature 17651 Biscayne Blvd. Aventura, FL 33160 I Phone I Fax EFTA00521203