CREDIT CARD USAGE AUTHORIZATION FORM

  PLEASE Print and complete entire form         Today’s date ___________

Card Holders/Members Name; ____________________________________

Billing Address of Credit Card; ___________________________________

City, State, Zip; ________________________________________________

  Phone_____________, Fax_____________ Mobile,____________________

Company Name; ___________________________________

Company Address; _________________________________

City, State, Zip; ____________________________________

Shipping Address; __________________________________

  City, State, Zip,_______________________________________

  I, (Card Holder)______________________, am the authorized user and give my permission to debit/charge of this credit card in reference for merchandise offered by Taylor Enterprises- 2253 Bluegrass Pl. – Independence, Ky, 41051,  859/356-9666  for a period of _______________ or until such that I submit in writing prior to any order, the expiration of usage by Taylor Enterprises

Card Number _______________________Exp Date: _______ CID # ___  (Last 3 numbers on the back of the card, four on Amex card)

I also authorize the following employees / associates to charge / debit this card on my behalf for the merchandise purchased from Taylor Enterprises________________,_______________________,____________________

Card Holders Signature Indicates Consent and Acknowledgement of the Afore Mentioned Transaction

Card Holder’s Signature: _______________________
          Today’s Date :   ____________________________

On a separate piece of paper place driver’s license and credit card listed on this form, enlarge and photocopy and return with this authorization form to Taylor Enterprises by fax.   Call Taylor Enterprises at 859/356-9666 to make sure the fax machine is on and then fax to 859/356-9666. This form must be completed in full and submitted with copy of credit card and your drivers license to be valid