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Credit Card Autho Form

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American Cooling And Heating 745 N. Gilbert Rd. Suite 124/276 Gilbert Arizona 85234 Phone (480) 699-2516 Fax (480) 699-0461 CREDIT CARD AUTHORIZATION DESCRIPTION OF CHARGES: FOR SERVICE PERFORMED BY AMERICAN COOLING AND HEATING. THE DETAILS OF SERVICE PERFORMED ARE PROVIDED ON A SEPARATE SERVICE INVOICE Please complete your information in all boxes below: CUSTOMER FULL NAME ON CREDIT CARD: CUSTOMER COMPLETE BILLING ADDRESS: ADDRESS OF JOBSITE WHERE SERVICE IS PERFORMED: PAYMENT DETAILS: Date: Authorized Amount To Charge: Card Number: Exp. Date: Card Type: Sec. Code On Back: THE UNDERSIGNED ACCEPTS ALL CHARGES AND AUTHORIZES PAYMENT FOR SERVICES: Authorized Signature (Must Match CC): Please completely fill out, sign, and fax to: (480) 699-0461 Do not email! An emailed form will not be accepted.