EXPO MEDIA, INC
4846 N. University Drive Suite 134
Ft. Lauderdale, FL 33351
Phone: 754-246-6112
Fax: 954-462-6672
Credit Card Authorization Form
CARD HOLDER INFORMATION |
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Name or Company Name: |
Billing Address (associated with the credit card being used): |
City:
State:
Zip:
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Email Address:
Phone:
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CARD HOLDER INFORMATION |
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Card Type:
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Card No.:
Exp. Date:
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Card Identification Number (CVV2 Code):
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I, ,authorize EXPO MEDIA, INC. to process a charge against my credit card account in the amount of $ for the payment of exhibit space and marketing fees at the National Pizza & Pasta Show. |
Print Name as it appears on Credit Card:
Signature:
Date:
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Note: EXPO MEDIA, INC. does not keep a file of credit card numbers. At the completion of the transaction, this document with your credit card number will be shredded. |