CREDIT CARD AUTHORIZATION FORM

Legacy Cabinets accepts the following credit cards: VISA, MASTERCARD and DISCOVER.

We do not accept AMEX.

Would you like to keep this card on file for future payments?

YESNO

By filling out this form, I / We authorize Legacy Cabinets, Inc. to charge my credit card for the amount indicated.

Accounts with terms will be charged the following fees:

Charge within 5 days of invoicing - additional 3% processing fee will be applied

Charge after 5 days of invoicing - additional 4% processing fee will be applied

All cash on order account payments will have a 4% processing fee

Email*

example@example.com

Legacy Customer Number*

Company Name*

Name on credit card*

Credit card number*

Expiration Date*

Security Code*

Billing Address*

Amount of charge*

Order or invoice numbers*

Printed name*

Submitting this form automatically submits the information to skearley@legacycabinetsllc.com. Thank you for your payment, your receipt will be emailed or faxed to you once payment has been processed. If you have any questions or concerns please contact me at 800-813-1112 ext. 135.

Signature*

Date*

Date