Credit Card Authorization Form

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This form must be filled out completely in order for us to process your request.


Account # ______________________________________________________________


Company Name: _________________________________________________________

PLEASE CHECK CREDIT CARD TYPE

Visa _____  Master Card _____ Company Card _____ Personal _____ Debit ________


Credit Card Number: _______________________________ Exp. Date: ____________


Name on card: ___________________________________________________________


Billing Address: _____________________________________ City: _______________


State: ___________ Zip code: _________ Phone number: ________________________


Signatures (Please sign and print your name)

_______________________________________________________________________

IMPORTANT NOTE

Note: Please provide a photo copy of both front and back of credit card to be used for our records. Signature on back of the card must match signature on this form.

Persons authorized to use card mentioned above (Please Print)

_______________________________________________________________________     

Certificate of Resale

Applicants signature attests financial responsibility, ability, and willingness to pay our invoices in accordance with the terms and conditions as stated in our dealer price list.

FIRM NAME: __________________________________________________ I hereby certify that I hold a valid sellers permit number: __________________________________ Issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling Scuba Diving Equipment; that the tangible personal property described herein which I shall purchase from Universal Scuba Distributors Inc. Houston, Texas will be resold by me in the form of tangible personal property; provided, however, that in the event any such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay for the tax, measured by the purchase price of such property. Description of property to be purchased: Sporting Goods Equipment.

Signature: _______________________________________ Date: ___________________________

By and Title: ________________________________ Phone: _______________________________

(IMPORTANT: A copy of your sales Tax resale license is required for our files)

Please FAX OR MAIL all the required information to:
Universal Scuba Distributors Inc. 14230 Westheimer, Houston, TX. 77077
FAX: 281-493-4358 / Phone: 281-493-0344
Questions: You can contact us via e-mail at: usdscuba75@yahoo.com

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