MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C4C332.DD08D060" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01C4C332.DD08D060 Content-Location: file:///C:/D269C634/ChargeAuth2004.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Elegant Fax

GLOBAL TECHNICAL SOLUTIONS, INC

credit card authorization form=

facsimile transmittal credit card authorization sh= eet

to:

 

from:

 =

&nbs= p;

Global Technical Solutions, Inc

company:

 

date:

 

 

 

fax number:

 

total no. of pages including cover:

 

 

 

Phone number:

 

sender’s fax number

 

 

954-583-0012

Re:

 

Senders phone num,ber

Credit Card Fraud Prevention Form

 

954-583-8001

copy of  photo id & front & back of= card required WITH THIS FORM

Please Reply for o= rder processing to begin. = Fill out completely<= /span>

To process your order please supply the following information. No orders will be accepted without information requested.=

 

1.&n= bsp;      CUSTOMER NAME AS IT APPEARS ON CREDIT CARD:

 

Full Name 

2.     Credit Card Ty= pe (check one)  =  VISA        &= nbsp;     MasterCard  &n= bsp;            = ;     =  American Expre= ss

3.   &n= bsp;    Credit Card Number: __________________________________________= __

4.   &n= bsp;    Expiration Date: ________________________________________________

5.   &n= bsp;    Billing Address for this Credit Card: __________________________________

 <= /span>

GLOBAL TECHNICAL SOLUTIONS, Inc.

 Credit Card Authorization form

 

PLEASE FAX BACK TO 954-583-0012=

  1. 3 or 4 Digit Authentication number on card: ____________________
  2. Items being purchased:__________________________________________<= /li>

 

 

  1. Authorized Signature of Card Holder: _________________________________
  2. Shipping Instructions:_______________________________________________=

 

By signing this form you state that you are the person authorized to use this = card for purchases and you are personally responsible for all purchases charged = to this card by Global Technical Solutions, Inc. You further agree that by sig= ning this form you agree that Global Technical Solutions, Inc is held harmless f= or any Charge Backs resulting from any miss-use of this credit card. Included = in this fax is a charge slip that must be signed and returned.

 

Signature:______________________________________

Date:________________________________________

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