We are Your #1 Source for Parts & Equipment

HOME ABOUT US SERVICES CONTACT US  
Shopping Cart Content | | View Content | Checkout  

Credit Card Authorization Form

To expedite our process of your Purchase Order/Quotation Request, we will need your Credit Card information. When an order needs to be shipped to an address different from the billing address or when an international credit card is used, we need to obtain your authorization as well. With that purpose, please fill in the next form and submit it to us. Also, please fax to us at 305-392-9931 a copy of your Passport ID and back and front of your Credit Card, OR scan and email the completed form and the photocopies of the credit card to complete your order.

 

Credit Card information  
I, hereby authorize to charge my credit card account in the amount of US Dollars
Credit Card number
Name on Card
Card type
Expiration date
Authorization code (usually last three digits on the back of your card) Amex cardholders on the front of your card.
As the credit card holder, I also authorize R&L Exporting to charge my credit card for future purchases verbally approved by me.
Initials here:
Authorization Valid Until:
Credit Card Billing Address
City
State
Zip/Postal Code
Country
   
Requested Shipping Address
City
State
Zip/Postal Code
Country
Your email address to send you a copy of this authorization
Any comments you may have