Led Cool Lights Credit Card Form

LED COOL LIGHTS

"Credit Card Approval Form"

  1. For the protection of your credit card information.
  2. Please Print this web-page CCAF
  3. Fax back to LED COOL LIGHTS.
  4. Phone: (866) 845-2526
  5. Fax: (972) 739-0729
  6. Sales@ledcoolights.com
  7. Provide your UPS/ FEDEX : __________________
  8. YOUR P.O. # : __________________
  9. Date You Must receive: ____/____/_____
Method of Payment:

please circle one		 VISA Master Card AmEx Discover

CREDIT CARD NUMBER
                               
EXPIRATION DATE
       




Signature:__________________________________________________

REQUIRED FOR CREDIT CARD ORDERS
Bill to: Ship to: (If different than "Bill to")
Name________________________________ Name________________________________
Company_____________________________ Company_____________________________
Street*_______________________________ Street*_______________________________
City__________________St./Prov._________ City__________________St./Prov._________
County________________________ County________________________
Zip+4/Postal Code__________Country_______ Zip+4/Postal Code__________Country_______
Phone(s)______________________________ Phone(s)______________________________
E-Mail Address:__________________________ 
  • * Street address required for FEDEX/UPS orders. No PO addresses.  What Shipping Service Level do you require: 1 day / 2 Day / Ground