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Credit Card Authorization Form - SCOTT'S USED PARTS

    Order Number/Item Description

    Ordered From:

    Type of Card Being Used:

    Credit Card Number:

    Expiration Date:

    CVC Security Code (*Last 3 digits on the back of the card.):

    Please Upload a Copy of Your Photo ID:

    Credit Card Billing Address

    First and Last Name

    Street

    City

    State

    Zip Code

    Phone

    Requested Shipping Address

    First and Last Name

    Street

    City

    State

    Zip Code

    Phone

    Cardholder's Signature

    Email:

    Date:

    As the credit card holder, I hereby authorize Scott's Auto Inc. to charge my credit card in the amount of purchase (including shipping and/or taxes, if applicable).

    As the credit card holder, I hereby authorize receipt of merchandise at the shipping address above, and agree to vendor's in store policies.

    Your completion of this authorization form helps us to protect you, our valued customers, from credit card fraud. All information entered on this form will be kept strictly confidential by our company.

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