Credit Card Authorization Form Credit Card Authorization Form If you are human, leave this field blank. Name of Officer/Agent * Business Entity Name or D/B/A Address * Complete address with city, state, zip code Phone Number * Fax Number Type of Credit Card to be used: * Visa MasterCard Discover American Express OtherOther Card Number * Expiration * CID (Card Identifaction #) * Name as it appears on the card: * Billing Address (if different from above) Paragraph Text IN SUBMITTING THIS FORM, I (WE) AUTHORIZE SUPREME SEAT COVERS TO CHARGE ALL OPEN ___DAILY ___ MONTHLY INVOICES FOR THE TOTAL AMOUNT DUE PLUS A 3% PROCESSING FEE. I (WE) CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND TRUE. I (WE) AGREE THAT, IN THE EVENT OF DISHONORED CREDIT, TO PAY THE AMOUNT IN FULL ON DEMAND ALONG WITH ANY AND ALL FEES ASSOCIATED WITH THE COLLECTION OF SAME. FURTHER, I ACKNOWLEDGE TO BE OF FULL AUTHORITY TO LEGALLY ENTER INTO THIS AGREEMENT ON BEHALF OF MYSELF AND THE ABOVE NAME COMPANY.