EFTA00521202.pdf

artefacto II III Credit Card Holder's Authorization October 23, 2018 hereby authorize artefacto to charge my credit card as follows: Visa Master Card Amex • Number it : • Expiration Date: • Security code: • In the amount of: $ 2,613.63 • For Sales Order II: PO 106861/55 and 106811/55 IMPORTANT NOTE: PLEASE ATTACH A COPY OF YOUR DRIVER'S LICENSE. By signing below, I acknowledge the charges described here on. Payment in full to be made when billed or in extended payment in accordance with standard policy of issuing card Company. Name as it Appears on Card: Billing Address: City: State: Zip: Signature Date 19 9 15 Biscayne Blvd. Avenluro, FL 33180 Phone: Fax: EFTA00521202