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Seawide Marine Distribution 2016

41698 Eastman Drive, Murrieta, CA 92562 Phone: (949) 515-5360 Fax: (951) 600-8530 www.seawide.com CREDIT CARD AUTHORIZATION 4 Must be completed if you are using a credit card* I, (Print Name) _________________________, do hereby authorize Seawide Marine Distribution to charge the following credit card for purchases made under the customer name of ___________________________. Card Type Visa MasterCard American Express Name printed on card ____________________________________________ Company Card Yes No Phone ________________________________ Email Address _______________________________________ Security Code #: Code must be provided at time of order (3 digits V/MC – 4 digits AMEX) Card #_________________________________________________ Expiration date _____________________ Card Billing Address ______________________________ City ____________ State ____ Zip_______-_____ Your card will be kept on file for future orders unless you specify that this is a one-time credit card authorization. Check box if card authorized for one time use only Invoice # or Sales order # _____________________________ Include copy of front and back of credit card *Credit card cannot be used to make payments on product ordered on net or discounted terms. *Third Party credit cards will not be accepted. Authorized Signature/Cardholder _________________________________ Title _______________________ Print Name _______________________________________________________Date ____________________ (Please SIGN and PRINT name above. NOTE: Signature Must Be Authorized Cardholder)


Seawide Marine Distribution 2016
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