Credit Card Ordering Information
Email address: officemanager@novavisioninc.com
Fax: After entering the information, print out and fax to: 419-353-7908
I am requesting to use my credit/debit card for payment on all future orders for my account using the following information:
1. Name (exactly as shown on the card)
2. Card Type (VISA, MasterCard, etc)
3. Card Number: (NOTE: Since email is not secure, do
not email the card number - instead phone or fax us the
card number)
4. Expiration Date:
5. Last 3 digits of the security code in the signature panel on back of card:
6. Mailing Address and Zip Code where billing statements are mailed:
7. The name and HOME phone number of the person authorizing the use of this card:
NOTE: All orders processed by credit & debit card payments are shipped by
means which do not require a signed authorization of material receipt. If you
require signed authorization to accept product, please indicate here:
______ No, I do not require signed authorization to accept product
______ Yes, only ship product which requires a signature to accept the product
Your Name: _________________________________
Company Name: _____________________________
Office Telephone: ____________________________
Fax: _______________________________________
Mailing Address: _____________________________