Business Credit Card Authorization Form

This is to authorizate Audio Video Service Labs / Kenwood Service Center East to charge all repairs for (Business Name) ___________________________________________ to

(Personal Card / Business Card) Visa / Master Card / Discover / Diners card number ________________________________________________

Exp Date _____________

CVV2/CVC2/CID Number____________ (See back of credit card)

Billing Name:

Billing Address:

Billing City / State / Zip:

Please ship my product as follows:

(You need not complete this section if the shipping address is the billing address.)

Shipping Name:

Shipping Address:

Shipping City / State / Zip:

Signature of Credit Card Holder: ___________________________________________________

Print Signature Name:____________________________________________________________

Date:

Fax Reply: (757) 340-6809

WE DO NOT ACCEPT DEBIT / CHECK CARDS for mail order sales. I understand that all parts sales are final.