Equipment Exchange Resource Systems, Inc.
8836 Washington Blvd. Unit #206
Jessup, Md 20794
Phone:301-362-9823 Fax:301-362-9826

Credit Card Payment  Authorization Form

Credit card goes here

 

 

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Place your credit card in the square above and make a photocopy of this form. Fill out the information below and fax it to us at 301-362-9826
I ____________________________________________   authorize Equipment Exchange Resource Systems, Inc.
Charge my  Visa   Master Card  American Express   Diners Club   
Number#  __________________________________________ Exp. Date _____________________________
Shipping Address:

 


Auction number : Phone Number:
Auction Site Ebay   Yahoo  Amazon
Item Description :
Item price  $
Shipping  $
Tax $
Sub Total $
3% Credit card fee

$

Total $
_______________________________________________ _________________________

Signature

Date