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Late Model Import Authorization to Use Credit Card For questions concerning your order, ask for your salesperson at 817-872-1491. We accept Visa, Master Card, Discover and American Express. PLEASE FAX THE COMPLETED FORM TO US AT 817-872-1495. Date: _____________________ Cardholder Name: __________________________________ Billing Address: __________________________________ __________________________________ Phone Number ___________________ Fax Number _______________ Card Type: __________________________________ Card Number: __________________________________ Expiration Date: __________________________________ VCode: __________________________________ (back of card or front on Amex) Order Description: ___________________________________________________________ ___________________________________________________________ I hereby authorize Late Model Import to charge the order as described above on my credit card whose information I provided above. I understand that this order is placed via the telephone and my signature on this agreement is binding. This purchase is for used automotive parts. All invoices are FOB Haltom City, Texas. I understand that if for any reason I refuse this shipment, freight charges will be charged to my credit card. These parts carry a 90 day warranty unless otherwise specified on the invoice. I understand that any tampering, disassembly, or modification of these parts will void all warranties. All parts returned must be returned complete and in the same condition as originally shipped and are subject to a restocking fee. If a return is necessary, you must contact your sales person to obtain a return authorization. Any parts returned without authorization will be refused any no credit will be issued. Authorized Amount _$________________________________
Card Holder Signature __________________________________ Printed Name ________________ |