Credit Card Authorization - parklandcollection

Credit Card Authorization Form

10501 NW 50th Street
Suite No 102
Sunrise, FL 33351
(954) 541-5163
orders@parklandcollection.com

I, from , hereby authorize Parkland Collection LLC to charge my credit card account for purchases and incidental shipping charges or charges back billed to Parkland Collection. I authorize Parkland Collection to keep this card on file for all future purchases or order related incidentals mentioned above.

visa
Master Card
American Express
Discover

Name On Credit Card

Credit Card Number

Expiration Date:

3-Digit VID Code:

Credit Card Authorization Form

Street:

City:

State:

Zip:

Telephone:

Cardholder-sign

Date:

Your completion of this authorization form helps us protect you, our valued customer, from credit card fraud. Parkland Collection will keep all information entered on this form strictly confident