Led Cool Lights Credit Card Form
LED COOL LIGHTS
"Credit Card Approval Form"
- For the protection of your credit card information.
- Please Print this web-page CCAF
- Fax back to LED COOL LIGHTS.
- Phone: (866) 845-2526
- Fax: (972) 739-0729
- Sales@ledcoolights.com
- Provide your UPS/ FEDEX : __________________
- YOUR P.O. # : __________________
- Date You Must receive: ____/____/_____
| Method of Payment: please circle one |
VISA | Master Card | AmEx | Discover |
| CREDIT CARD NUMBER
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EXPIRATION DATE
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Signature:__________________________________________________ REQUIRED FOR CREDIT CARD ORDERS |
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| 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:__________________________ | |
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