KV COLLECTIONS, INC. 6832 East Slauson Ave.
Commerce, CA 90040 Phone: (323) 888-1036 Fax: (323) 888-9525 www.kavio.com
CREDIT CARD SALE BY FAX
* For your safety do not save nor e-mail us with your credit card information instead please only print-out this form and FAX to us at (323) 888-9525.
_________________________________________________
Sales Associate's Name:
Phone Ext#:
Dept: Sales/Customer Service
The purpose of this letter is to authorize KV Collections INC., dba KAVIO! to charge the following credit card shown below in the amount stated per phone sale order.
Form must be completed in full by authorized user of the card.
_________________________________________________
Company Name:
Cardholder's Name:
Cardholder's Billing Address:
City:
State:
Zip Code:
Customer's Billing Phone:
Cell Phone:
Work Phone:
Customer's Fax:
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CREDIT CARD INFORMATION
CREDIT CARD #:
Expiration Date:
Circle one:
Amex
Visa
Master
Discover
Name of Bank on Credit Card:
Date Signed:
Amount Authorized:
Customer's Authorization Signature:
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