"Big enough to supply all your import needs, yet small enough to be dedicated to your business."

6861 S. W. 196th Avenue, Suite #116, Pembroke Pines, Florida USA 33332         Phone - 954.689.0299      Fax - 954.689.4928

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CREDIT CARD AUTHORIZATION

*Credit Card Number/Numero do Cartao de Credito
  
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*Credit Card Holder Name/Nome conforme aparece no cartao 
 

*Billing Address of Card Holder/Endereco de Cobranca do Cartao
 

*City - State - Country - Zip/Cidade - Estado - Pais - CEP
 
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*Expiration Date/Data de Expiracao
 
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*Phone of Credit Card Holder/Fone do Propreitario do Cartao
 
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*Fax of Credit Card Holder/Fax do Proprietario do Cartao 
 
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*Date/Data
 
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*For/Finalidade
 
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Please note that to process your order you must fax a copy of the front and back of your credit card to 954.689.4928 .

Thank you.

Copyright 2001 Western Tek, Inc.