Credit/Debit Card Authorization


I, hereby authorize AaaTeX to charge my credit / debit

card below for $ . I acknowlege that I am authorized to make this purchase

and use this card.


Most information my be left blank and called/faxed in.

Card Type (Visa, MC, AmEx, Discover)
Credit Card Number (at least last 4 digits)
Expiration Date
Code on Back (CVV)
Name on Card
Business Name
Card Billing Addr
Card Billing Postal Code
Card Billing Phone No

I achknowledge that I have read and accept the AaaTeX policies that

that are posted on their web site at www.AaaTeX.com/Policies.htm.

Signed by

Form can be emailed back to mgmt@AaaTeX.comor

faxed to 386-788-4189 (must be signed if faxed)