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Print this form, complete all
fields, sign and fax to your move coordinator |
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To:
Rossiter Relocation
FAX: 925-371-0786
From:
_______________________________
Page
_____ of _____
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CREDIT CARD AUTHORIZATION FORM |
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CREDIT
CARD NUMBER:
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EXPIRATION DATE (MMDDYY): |
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ROSSITER RELOCATION
6475 Las Positas
Livermore, CA 94551 |
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PURCHASER SIGN HERE |
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X
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Cardholder acknowledges receipt of goods and/or services in the amount of
the Total shown hereon and agrees to perform the obligations set forth in
the Cardholder's agreement with the issuer. |
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DATE |
AUTHORIZATION |
SUB
TOTAL |
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REFERENCE NO |
TAX |
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TIPS |
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SALES
SLIP |
TOTAL |
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