Home » Credit Card Authorization Form
*Attn:
*Date:
*Customer:
*From:
*Phone:
*Page:
*Email:
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I authorize Aero Express, Inc. to charge my credit card item(s) shipped against my Purchase Order Purchase Order for the amount of Purchase Amount. A 3% credit card fee will be added to the amount of purchase.
The billing address of my card is:
*Name of Cardholder: *Street Address:
*City:
*State:—Select—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
*Zip Code:
*Country:
*Credit Card Type:—Select—VisaMastercardAmerican Express (Amex)Discover
For security purposes, we will call you to obtain your credit card number, expiration date and security code.
*Issuing Bank (on credit card): *Bank Telephone# on card:
*Authorized Signature:
Please note: the street address and Zip Code must match the Credit Card Billing address in order to process your order