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26395 Groesbeck Hwy.Warren, MI. 48089
P: 586-779-1088F: 586-779-8598
m97autodealer.comEmail: [email protected]
Credit Card Authorization Form
Item(s) Ordered: Camera 2002 Deville
Total Cost/Deposit Amt: Total price with Shipping: $140
Name as it Appears on Card: Tiffany Y Shepard
Billing Address: 542 Owl ln.
City/State/Zip: Elgin S.C. 29045
Credit Card Account #:4037 6600 3002 4079
Expiration Date (mo./yr.): 08 / 16
3-Digit V-Code on back of Card ( 4 digit on front for AMEX.): 275
I authorize M-97 AUTO PARTSto charge my credit card for the amount listed above.Signature of Cardholder:
Date of Purchase: 8 / 21 / 2013Phone: (803) 729-4022
Shipping / Delivery Address (if diff. than billing):_______________________________ _______________________________ _______________________________ Sales Tax ID # (if applicable):_______________________________________________
*All items sold as is. No Refunds on electrical items.Returns are accepted for In-Store credit only plus a 25% restock fee.
