WE DELIVER

888-675-0006

Xpress One NY inc.

Card Type *

Security Code *

Select Billing Terms: *

7 Net 5% off

Same Day 10% off

30 Net At Standard Rate

Sender Email *

Name of Authorized User(s) *

Exp Year *

Exp Month *

CUSTOMER CREDIT CARD FORM

AUTHORIZATION TO CHARGE CREDIT CARD

This form authorizes Xpress One to charge the credit card listed for all invoice amounts, without subsequent prior written or verbal notification to the cardholder.

It is your responsibility to contact Xpress One’s accounting department of any changes in your credit card account, in order to arrange for an alternate card to be used.

PLEASE COMPLETE THE FOLLOWING:

Company Name:

Full Name *

Card Billing Address *

Card Number: *