By checking the BLANKET AUTHORIZATION box, the customer authorizes J. Van Vliet New York LLC to charge all orders to the referenced credit card account for a period of one (1) year. For your records, copies of each charge to this account will be faxed or mailed / emailed to you.
(if applicable or different from above)
The above signature authorizes payment by the referenced credit card account to J. Van Vliet New York, LLC.PLEASE COMPLETE THIS FORM AND FORWARD IT TO THE ACCOUNTS RECEIVABLE DEPARTMENT.
FAX: 718-786-5997 / firstname.lastname@example.orgThank You!